VTE increases risk of flap failure after head and neck free flap surgery: Study

The study is published in the Journal of Otolaryngology- Head and Neck Surgery.

Meghan M. Crippen and colleagues from the Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA carried out the present study with the sole objective to investigate if a history of venous thromboembolism (VTE) is a risk factor for complications in head and neck free flap surgery by assessing outcomes among patients with a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE).

The authors carried out a retrospective cohort study at a single tertiary care center. All patients undergoing head and neck free flap reconstruction at the institution, were assessed for inclusion. Patients with and without a history of DVT or PE preoperatively were identified and grouped for comparison.

Groups were compared for demographics, comorbidities, and 30-day complications. Significance was assessed with chi-square and binary logistic regression analyses.

The following results were observed-

3. Of the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE.
4. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], P = .038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, P = .010) and stroke (27.5% vs 4.5%, P < .001).
5. After accounting for patient characteristics via binary logistic regression, VTE was independently associated with an increased risk for postoperative thrombosis of the free flap pedicle (odds ratio [95% CI] = 3.65 [1.12-11.90], P = .032) and reoperation (2.45 [1.25-4.80], P = .009).
6. Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77-33.52], P = .007).
7. Prior VTE was not independently associated with an increased risk for medical complications or readmission.

Therefore, the authors concluded that "patients with a history of VTE may be at an increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in preoperative workup and postoperative monitoring."