Outcomes in Head and Neck Free Flap Reconstruction Among Patients With a History of Venous Thromboembolism.

[OBJECTIVE] To investigate if a history of venous thromboembolism (VTE) is a risk factor for complications in head and neck free flap surgery by assessing outcomes among patients with a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE).

[STUDY DESIGN] Retrospective cohort study.

[SETTING] Single tertiary care center.

[METHODS] All patients undergoing head and neck free flap reconstruction at our institution between September 1, 2006, and April 2, 2020, were assessed for inclusion. Patients with and without a history of DVT or PE preoperatively were identified and grouped for comparison. Groups were compared for demographics, comorbidities, and 30-day complications. Significance was assessed with chi-square and binary logistic regression analyses.

[RESULTS] Of the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], = .038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, = .010) and stroke (27.5% vs 4.5%, < .001). After accounting for patient characteristics via binary logistic regression, VTE was independently associated with an increased risk for postoperative thrombosis of the free flap pedicle (odds ratio [95% CI] = 3.65 [1.12-11.90], = .032) and reoperation (2.45 [1.25-4.80], = .009). Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77-33.52], = .007). Prior VTE was not independently associated with an increased risk for medical complications or readmission.

[CONCLUSION] Patients with a history of VTE may be at an increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in preoperative workup and postoperative monitoring.