Prospective study of venous thromboembolism in patients with head and neck cancer after surgery

Daniel Clayburgh, Will Stott, Teresa Cordiero, Renee Park, Kara Detwiller, Maria Buniel, Paul Flint, Joshua Schindler, Peter Andersen, Mark Wax, Neil D. Gross

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

IMPORTANCE: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in surgery patients, but little data exist on the incidence of VTE in head and neck cancer surgical patients. OBJECTIVE: To determine the incidence of VTE in postoperative patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery. MAIN OUTCOME AND MEASURE: Total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging. RESULTS: Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13%. Eight participants were identified with clinically significant VTE: 7 DVT and 1 PE. An additional 5 participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1%) was higher than that in patients without anticoagulation therapy (5.6%) (P = .01). CONCLUSIONS AND RELEVANCE: Hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE. Bleeding complications are elevated in patients receiving postoperative anticoagulation.

Original languageEnglish (US)
Pages (from-to)1143-1150
Number of pages8
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume139
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Venous Thromboembolism
Head and Neck Neoplasms
Prospective Studies
Ambulatory Surgical Procedures
Pulmonary Embolism
Venous Thrombosis
Incidence
Hemorrhage
Chemoprevention
Diagnostic Imaging
Tertiary Healthcare
Therapeutics
Lower Extremity
Morbidity
Mortality

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

Prospective study of venous thromboembolism in patients with head and neck cancer after surgery. / Clayburgh, Daniel; Stott, Will; Cordiero, Teresa; Park, Renee; Detwiller, Kara; Buniel, Maria; Flint, Paul; Schindler, Joshua; Andersen, Peter; Wax, Mark; Gross, Neil D.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 139, No. 11, 11.2013, p. 1143-1150.

Research output: Contribution to journalArticle

Clayburgh, Daniel ; Stott, Will ; Cordiero, Teresa ; Park, Renee ; Detwiller, Kara ; Buniel, Maria ; Flint, Paul ; Schindler, Joshua ; Andersen, Peter ; Wax, Mark ; Gross, Neil D. / Prospective study of venous thromboembolism in patients with head and neck cancer after surgery. In: JAMA Otolaryngology - Head and Neck Surgery. 2013 ; Vol. 139, No. 11. pp. 1143-1150.
@article{4020c1248d9948c58a2cd1d130c57e20,
title = "Prospective study of venous thromboembolism in patients with head and neck cancer after surgery",
abstract = "IMPORTANCE: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in surgery patients, but little data exist on the incidence of VTE in head and neck cancer surgical patients. OBJECTIVE: To determine the incidence of VTE in postoperative patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery. MAIN OUTCOME AND MEASURE: Total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging. RESULTS: Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13{\%}. Eight participants were identified with clinically significant VTE: 7 DVT and 1 PE. An additional 5 participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1{\%}) was higher than that in patients without anticoagulation therapy (5.6{\%}) (P = .01). CONCLUSIONS AND RELEVANCE: Hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE. Bleeding complications are elevated in patients receiving postoperative anticoagulation.",
author = "Daniel Clayburgh and Will Stott and Teresa Cordiero and Renee Park and Kara Detwiller and Maria Buniel and Paul Flint and Joshua Schindler and Peter Andersen and Mark Wax and Gross, {Neil D.}",
year = "2013",
month = "11",
doi = "10.1001/jamaoto.2013.4911",
language = "English (US)",
volume = "139",
pages = "1143--1150",
journal = "JAMA Otolaryngology - Head and Neck Surgery",
issn = "2168-6181",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - Prospective study of venous thromboembolism in patients with head and neck cancer after surgery

AU - Clayburgh, Daniel

AU - Stott, Will

AU - Cordiero, Teresa

AU - Park, Renee

AU - Detwiller, Kara

AU - Buniel, Maria

AU - Flint, Paul

AU - Schindler, Joshua

AU - Andersen, Peter

AU - Wax, Mark

AU - Gross, Neil D.

PY - 2013/11

Y1 - 2013/11

N2 - IMPORTANCE: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in surgery patients, but little data exist on the incidence of VTE in head and neck cancer surgical patients. OBJECTIVE: To determine the incidence of VTE in postoperative patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery. MAIN OUTCOME AND MEASURE: Total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging. RESULTS: Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13%. Eight participants were identified with clinically significant VTE: 7 DVT and 1 PE. An additional 5 participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1%) was higher than that in patients without anticoagulation therapy (5.6%) (P = .01). CONCLUSIONS AND RELEVANCE: Hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE. Bleeding complications are elevated in patients receiving postoperative anticoagulation.

AB - IMPORTANCE: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in surgery patients, but little data exist on the incidence of VTE in head and neck cancer surgical patients. OBJECTIVE: To determine the incidence of VTE in postoperative patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery. MAIN OUTCOME AND MEASURE: Total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging. RESULTS: Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13%. Eight participants were identified with clinically significant VTE: 7 DVT and 1 PE. An additional 5 participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1%) was higher than that in patients without anticoagulation therapy (5.6%) (P = .01). CONCLUSIONS AND RELEVANCE: Hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE. Bleeding complications are elevated in patients receiving postoperative anticoagulation.

UR - http://www.scopus.com/inward/record.url?scp=84892396388&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892396388&partnerID=8YFLogxK

U2 - 10.1001/jamaoto.2013.4911

DO - 10.1001/jamaoto.2013.4911

M3 - Article

C2 - 24076972

AN - SCOPUS:84892396388

VL - 139

SP - 1143

EP - 1150

JO - JAMA Otolaryngology - Head and Neck Surgery

JF - JAMA Otolaryngology - Head and Neck Surgery

SN - 2168-6181

IS - 11

ER -