Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Faculty of Medicine Mannheim, Ruprecht Karls University Heidelberg, Mannheim, Germany.
JAMA Otolaryngol Head Neck Surg. 2022 Nov 1;148(11):1051-1058. doi: 10.1001/jamaoto.2022.2551.
Venous thromboembolism (VTE) is a severe complication after free tissue transfer to the head and neck (H&N). Enoxaparin 30 mg twice daily (BID) is a common regimen for chemoprophylaxis. However, differences in enoxaparin metabolism based on body weight may influence its efficacy and safety profile.
To assess the association between BMI and postoperative VTE and hematoma rates in patients treated with prophylactic enoxaparin 30 mg BID.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective review of a prospectively collected cohort from 2012 to 2022. Postoperative VTE, hematoma, and free flap pedicle thrombosis were recorded within 30 days of index surgery. The setting was a tertiary academic referral center. Participants included patients undergoing H&N reconstruction with free flaps that received fixed-dose subcutaneous enoxaparin 30 mg BID postoperatively. Statistical analysis was conducted from April to May 2022.
Outcomes include incidence of VTE, hematoma, and flap pedicle thrombosis events within 30 days of the surgery. Univariate and multivariable regression models were used to evaluate associations between BMI and other patient factors with these outcomes.
Among the 765 patients included, 262 (34.24%) were female; mean (SD) age was 60.85 (12.64) years; and mean (SD) BMI was 26.36 (6.29). The rates of VTE and hematoma in the cohort were 3.92% (30 patients) and 5.09% (39 patients), respectively. After adjusting for patient factors, BMI was the only factor associated with VTE (OR, 1.07; 95% CI, 1.015-1.129). Obesity (BMI >30) was associated with increased odds of VTE (OR, 2.782; 95% CI, 1.197-6.564). Hematoma was not associated with BMI (OR, 0.988; 95% CI, 0.937-1.041). Caprini score of at least 9 was not associated with VTE (OR, 1.259; 95% CI, 0.428-3.701).
This cohort study found that obesity was associated with an increased risk of VTE in patients after microvascular H&N reconstruction and while on standard postoperative chemoprophylaxis regimens. This association may suggest insufficient VTE prophylaxis in this group and a potential indication for weight-based dosing.
静脉血栓栓塞症（VTE）是头颈部（H&N）游离组织移植后的严重并发症。依诺肝素 30mg，每日两次（BID）是常见的化学预防方案。然而，基于体重的依诺肝素代谢差异可能会影响其疗效和安全性。
评估 BMI 与接受预防性依诺肝素 30mg BID 治疗的患者术后 VTE 和血肿发生率之间的关系。
设计、地点和参与者：这是一项回顾性研究，对 2012 年至 2022 年期间前瞻性收集的队列进行了分析。术后 30 天内记录了 VTE、血肿和游离皮瓣蒂血栓形成。该研究地点为三级学术转诊中心。参与者包括接受 H&N 重建并接受术后固定剂量皮下依诺肝素 30mg BID 的游离皮瓣患者。统计分析于 2022 年 4 月至 5 月进行。
结局包括手术后 30 天内 VTE、血肿和皮瓣蒂血栓形成事件的发生率。单变量和多变量回归模型用于评估 BMI 与其他患者因素与这些结局之间的关系。
在纳入的 765 名患者中，262 名（34.24%）为女性；平均（SD）年龄为 60.85（12.64）岁；平均（SD）BMI 为 26.36（6.29）。该队列的 VTE 和血肿发生率分别为 3.92%（30 例）和 5.09%（39 例）。在调整患者因素后，BMI 是唯一与 VTE 相关的因素（OR，1.07；95%CI，1.015-1.129）。肥胖（BMI＞30）与 VTE 的发生几率增加相关（OR，2.782；95%CI，1.197-6.564）。BMI 与血肿无关（OR，0.988；95%CI，0.937-1.041）。Caprini 评分≥9 与 VTE 无关（OR，1.259；95%CI，0.428-3.701）。
本队列研究发现，肥胖与接受微血管头颈部重建和标准术后化学预防方案的患者 VTE 风险增加有关。这种关联可能表明该组患者的 VTE 预防不足，可能需要根据体重进行剂量调整。
