Post-operative venous thromboembolism in patients after extracranial otologic surgery: A case series

Abstract

Objective: This study aimed to report 9 venous thromboembolism (VTE) cases after extracranial otologic surgery and analyze the potential risk factors. Study design: Case series. Setting: Single tertiary-level academic center. Methods: Totally, 9 cases of VTE were identified among adults who underwent extracranial otologic surgery at our hospital from January 2018 to December 2020. Caprini risk scores were calculated, and comprehensive preoperative, operative, and postoperative clinical data within 14 days were collected to assess the evidence of VTE. Results: The median age of 9 patients was 64 years old. Among them, 7 (77.8%) patients presented with intramuscular vein thrombosis, 1 (11.1%) patient had deep vein thrombosis, and 1 (11.1%) patient experienced pulmonary embolism. Preoperatively, 8 (88.9%) patients had low or middle Caprini risk scores (≤4) with an average of 2.67 ± 0.47 points. The average Caprini scores for all patients were 4.44 ± 0.35 on postoperative day (POD)1 and 5.67 ± 0.64 on POD14. D-dimer levels were collected, indicating an average of 0.55 ± 0.17 mg/FEU preoperatively, 8.53 ± 3.94 mg/FEU at day 1, and 3.76 ± 0.45 mg/FEU at POD14. In postoperative period, 7 (77.8%) patients experienced vertigo/dizziness and/or head immobility/bed rest. Conclusion: The present study highlighted that patients with low- and middle-risk of VTE undergoing otologic surgery should be also vigilant about postoperative VTE. Vertigo/dizziness and/or head immobility/bed rest in postoperative period should be considered as minor risk factors for developing VTE in patients undergoing extracranial otologic surgery. Conducting perioperative assessments, including Caprini risk score evaluation, D-dimer testing, and venous ultrasound of lower extremities, is recommended to ensure patients’ safety.

Keywords

• Venous thromboembolism (VTE)
• Extracranial otologic surgery
• Caprini risk score
• D-dimer level