National Trends in Venous Thromboembolism in the Adult Craniofacial Trauma Population

Venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication in plastic surgery; however, there is a paucity of evidence about the incidence of VTE in the craniofacial subpopulation. We investigated the incidence and risk factors for VTE in the adult craniofacial trauma population.

This retrospective review identified patients from the 2016 and 2017 Healthcare Cost and Utilization Project's National Inpatient Sample with a diagnosis for an initial encounter of a facial fracture. International Classification of Disease codes identified patients with DVT or PE. Groups were identified: adult craniofacial patients with and without a VTE diagnosis. The groups were analyzed to determine risk factors for developing a VTE during inpatient admissions.

A total of 203,240 patients were identified based on a diagnosis for an initial encounter of a facial fracture. Among those, 3350 (1.65%) were diagnosed with a DVT and 1455 (0.72%) with a PE. Risk factors for VTE were male sex (P = 0.011), longer hospital stay (P = 0.000), and higher Elixhauser comorbidity index (P = 0.000). Additionally, PE was an independent predictor of mortality [odds ratio (OR), 2.129] but DVT was not (OR, 1.148). Cranial and frontal fractures were independently associated with an increase in DVT (OR, 2.481) and PE (OR, 1.489).

This study demonstrates that craniofacial trauma patients are at risk for VTE and should be risk-stratified for chemoprophylaxis therapy. Further studies in thromboembolism prophylaxis for facial fractures are warranted as the data are limited.