Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2022 Feb;166(2):267-273. doi: 10.1177/01945998211011999. Epub 2021 Jun 1.
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).
Retrospective cohort study.
Single tertiary care center.
All patients undergoing head and neck free flap reconstruction at our institution between September 1, 2006, and April 2, 2020, 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.
Of the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], = .038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, = .010) and stroke (27.5% vs 4.5%, < .001). 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], = .032) and reoperation (2.45 [1.25-4.80], = .009). Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77-33.52], = .007). Prior VTE was not independently associated with an increased risk for medical complications or readmission.
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.
通过评估有深静脉血栓形成（DVT）和/或肺栓塞（PE）病史患者的结局，研究静脉血栓栓塞症（VTE）病史是否是头颈部游离皮瓣手术并发症的危险因素。
回顾性队列研究。
单一的三级保健中心。
评估了 2006 年 9 月 1 日至 2020 年 4 月 2 日期间在我院接受头颈部游离皮瓣重建的所有患者，以确定是否符合纳入标准。确定并分组比较有和无术前 DVT 或 PE 病史的患者。比较两组的人口统计学、合并症和 30 天并发症。采用卡方检验和二项逻辑回归分析评估显著性。
符合纳入标准的 1061 例患者中，有 40 例（3.8%）有 VTE 病史。这些患者明显更年长（平均[标准差]，岁：67.8[11.7] vs 63.0[14.1]， =.038），且更有可能有化疗史（35.0% vs 18.7%， =.010）和中风史（27.5% vs 4.5%， <.001）。通过二项逻辑回归分析考虑患者特征后，VTE 与游离皮瓣蒂血栓形成（优势比[95%置信区间] = 3.65[1.12-11.90]， =.032）和再次手术（2.45[1.25-4.80]， =.009）的风险增加独立相关。有 PE 病史的患者皮瓣失败的风险显著增加（7.70[1.77-33.52]， =.007）。既往 VTE 与医疗并发症或再入院的风险增加无关。
有 VTE 病史的患者可能因术后蒂血栓形成而导致游离皮瓣功能障碍的风险增加。在术前检查和术后监测中应考虑这一风险。
