Floor plan - 2013 Annual Meeting - American Association for Hand ...

ASRM SCIENTIFIC PAPER PRESENTATIONS:
HEAD AND NECK
The Incidence of Venous Thromboembolism in Head and Neck Reconstruction
Institution where the work was prepared: Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Constance M. Chen, MD, MPH; Joseph J. Disa; Babak J. Mehrara; Memorial Sloan-Kettering Cancer Center
BACKGROUND:
Cancer patients undergoing head and neck reconstruction are at high risk for venous thromboembolism (VTE). Such patients often
exhibit major risk factors including advanced age, immobility due to a prolonged surgical procedure, malignant disease, and hypercoagulability.
Currently, no published data exist regarding the incidence of VTE in patients undergoing oncologic head and neck reconstruction.
This study evaluates the incidence of symptomatic pulmonary embolism (PE) and deep venous thrombosis (DVT) after head
and neck reconstruction at a single tertiary-care cancer center.
METHODS:
A retrospective review was done of 6759 surgical procedures performed between 1997 and 2006 at Memorial Sloan-Kettering Cancer
Center (MSKCC). Data from a prospectively maintained surgical database was reviewed to identify procedures that resulted in postoperative
PE or DVT.
RESULTS:
From 1997-2006, there were 6759 procedures performed by two surgeons at MSKCC. There were 1583 head and neck operations
(n=1583) and 5176 non-head and neck procedures (n=5176). Non-head and neck procedures included surgeries of the breast, upper
extremity, lower extremity, trunk, and back. When compared to patients undergoing procedures in other parts of the body, patients
undergoing oncologic head and neck reconstruction were older, spent more days in the hospital, and underwent longer anesthesia
times. While the incidence of VTE was less than 1% in both patient populations, there was a six-fold greater incidence of VTE among
patients undergoing head and neck surgery (0.57%) than non-head and neck surgeries (0.09%). The difference between the two groups
was statistically significant (p = 0.001).
CONCLUSIONS:
The incidence of pulmonary embolism was significantly higher in cancer patients undergoing head and neck reconstructions than in all
other types of procedures. Possible reasons include advanced age and prolonged immobility. When possible, anticoagulant therapy
for prophylaxis against VTE in cancer patients undergoing head and neck reconstruction is strongly recommended.
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