Venous Thromboembolism Risk Across Otolaryngology-Head and Neck Surgery Subspecialties: A National Database Analysis

To assess venous thromboembolism (VTE) rates across the spectrum of otolaryngology-head and neck surgery (OHNS) between and within subspecialties.

Retrospective national database study.

The Atropos database, a national aggregated cohort of 66 million patients across the United States, was queried for patients who underwent OHNS surgery.

Adult patients who had at least one Current Procedural Terminology code for OHNS procedures between 2015 and 2025 were assessed for the outcome of 90-day VTE. Postoperative VTE rates were compared within and between OHNS subspecialties. Risk factors for VTE outcomes were assessed using univariable analysis.

277,187 patients (mean age 58.6 ± 18.7 years, 46.8% male) who had OHNS surgery were included. Postoperative VTE occurred in 1735 (0.63%) patients. VTE rates were highest in head and neck (1.3%), followed by laryngology (1.0%), rhinology (0.6%), facial plastic and reconstructive surgery (0.5%), otology (0.5%), and sleep surgery (0.3%). Differential VTE rates for procedural groups within each subspecialty were observed. The procedural groups with the highest VTE rates were free tissue transfer (6.1%), lateral skull base surgeries (4.4%), cricopharyngeal myotomies (3.1%), and anterior skull base surgeries (3.1%). Prior VTE (OR 12.3 [95% confidence interval, 11.2-13.4]) was the covariate with the highest risk for postoperative VTE.

Although the overall VTE rate was low (0.6%), intersubspecialty and intrasubspecialty variation in VTE rates were observed, and a subset of OHNS procedures had substantially higher VTE risk. These findings may inform surgeon decision-making regarding chemoprophylaxis.