(A129) Implementation of a Novel VTE Risk Assessment Instrument for Otolaryngologic Surgical Patients

Introduction: Venous thromboembolic events (VTE) are a leading cause of post-operative morbidity, prolonged hospital stay, and increased cost. Recommendations for VTE chemoprophylaxis are traditionally based on the 2005 Caprini Risk Assessment model, though this model is often not used in many practice settings due to practical challenges with collecting all inputs required. We evaluate the implementation of the simplified COBRA (inpatient procedures) and Pannucci-NSQIP (ambulatory procedures) scoring systems at two large tertiary academic centers.

Methods: This is a prospective study capturing VTE scores for all ambulatory procedures and surgical admissions from Weill Cornell Medicine and Columbia University Medical Center starting 12/1/2024. VTE chemoprophylaxis recommendations were sent to all attending and resident team members. Admitted patients are followed for the duration of their hospitalization, and adherence to DVT chemoprophylaxis recommendations were assessed, including choice/duration of chemoprophylaxis and rationales when guidance is not followed.

Results: Of surgical procedures examined, 16% were surgical admissions and the remainder ambulatory. Of all surgical admissions, DVT chemoprophylaxis was recommended for 65.9% of patients based on a high-risk COBRA score. Of patients for whom DVT chemoprophylaxis was recommended, 50% of patients received chemoprophylaxis during their admission. One patient had post-operative bleeding requiring OR intervention. None had evidence of 30-day VTE. The reasons for not starting chemoprophylaxis included ambulation/discharge on POD1 (50%), low-risk surgery with no incision (16%), high risk of post-operative bleeding (16%), and non-ENT primary team (16%).

Of all ambulatory procedures, DVT prophylaxis was recommended for 11.9% of patients based on NSQIP score, though was not started for any patients as they were immediately ambulatory.

Conclusions: We outline a path to implementing a VTE risk calculator for otolaryngology surgical departments to track and improve adherence to DVT chemoprophylaxis recommendations and postoperative outcomes.