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

To evaluate the feasibility, process adherence, and clinical outcomes associated with department-wide implementation of simplified venous thromboembolism (VTE) risk assessment models (RAM) for inpatient and ambulatory otolaryngology surgical patients.

A mixed prospective and retrospective quality improvement initiative was conducted across two tertiary academic medical centers, including all scheduled adult otolaryngology surgical procedures from January 3, 2025, to November 20, 2025. Inpatient admissions were risk stratified using the COBRA score and ambulatory procedures using the Pannucci-NSQIP score; inpatient risk stratifications were shared with surgeons. High VTE risk was defined as COBRA ≥ 4 for inpatients and Pannucci-NSQIP ≥ 4 for ambulatory cases. Pharmacologic prophylaxis beginning on postoperative Day 1 was recommended for high-risk inpatients. Process measures included adherence to prophylaxis guidance and documented rationales for deviation. Outcome measures included 30-day VTE and hemorrhage events.

A total of 3854 consecutive adult procedures were included (608 inpatient, 3246 ambulatory). 65% of inpatients and 14% of ambulatory cases were classified as high risk. Among high-risk inpatients with length of stay ≥ 2 days, VTE occurred in 2.5% of patients receiving chemoprophylaxis on POD1 compared with 4.7% of those not receiving POD1 prophylaxis. No VTE events occurred in low-risk inpatients, high-risk inpatients discharged on POD1, or high-risk ambulatory patients. Hemorrhage rates were similar across prophylaxis groups (3.2%-4.1%). Overall VTE rates were 1.8% for inpatients and 0.1% for ambulatory procedures.

The simplified COBRA and Pannucci-NSQIP RAMs provide a feasible and potentially scalable framework for integrating VTE risk stratification into routine otolaryngology practice.