Implementation of a Novel VTE Risk Assessment and Prophylaxis Strategy for Otolaryngology Surgery

Area of Science:

• Otolaryngology surgical patient safety
• Thromboembolism risk assessment
• Quality improvement initiatives

Background:

• Venous thromboembolism (VTE) poses a significant risk to surgical patients.
• Accurate risk stratification is crucial for effective VTE prophylaxis.
• Current VTE risk assessment models (RAM) may lack simplicity for routine clinical use.

Purpose of the Study:

• To assess the feasibility and effectiveness of implementing simplified VTE RAMs in otolaryngology.
• To evaluate process adherence and clinical outcomes of department-wide VTE risk stratification.
• To integrate VTE prevention strategies into both inpatient and ambulatory otolaryngology care.

Main Methods:

• A mixed-methods quality improvement initiative was conducted across two academic medical centers.
• Inpatient and ambulatory otolaryngology surgical patients were risk-stratified using the COBRA and Pannucci-NSQIP scores, respectively.
• Pharmacologic prophylaxis was recommended for high-risk inpatients (COBRA ≥4, Pannucci-NSQIP ≥4) starting on postoperative Day 1.

Main Results:

• 3854 procedures were analyzed; 608 inpatient and 3246 ambulatory.
• 65% of inpatients and 14% of ambulatory cases were high-risk.
• High-risk inpatients receiving prophylaxis had a 2.5% VTE rate versus 4.7% without; no VTE in low-risk or discharged-early patients. Overall VTE rates were 1.8% (inpatient) and 0.1% (ambulatory).

Conclusions:

• Simplified COBRA and Pannucci-NSQIP RAMs are feasible for routine otolaryngology practice.
• These models offer a scalable framework for VTE risk stratification.
• Implementation can guide prophylaxis and potentially reduce VTE events in otolaryngology patients.