Venous Thromboembolism in Otolaryngology-Head and Neck Surgery: Systematic Review and Meta-Analysis.

Abstract

Venous thromboembolism (VTE) is a serious perioperative complication associated with morbidity and mortality. Although otolaryngology-head and neck surgery (OHNS) has lower rates of VTE than other surgical specialties, VTE rates and risk factors by subspecialty are not well characterized. This systematic review and meta-analysis aims to synthesize the published evidence on VTE in OHNS. Medline, Embase, CINAHL, Central, Scopus, and Web of Science databases were searched from inception to 10/06/2025. Clinical and observational studies of adult patients who underwent otolaryngologic surgery were included. Outcome measures included VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE) rates. Three independent reviewers evaluated each abstract and article. Heterogeneity and bias across studies were evaluated. Of 4329 studies identified, 212 met inclusion criteria, comprising 2,779,113 patients. The overall event rates were 0.008 for VTE (I² = 99%, prediction interval [PI] 0.001-0.100), 0.006 for DVT (I² = 99%, PI 0.000-0.066), and 0.005 for PE (I² = 97%, PI 0.001-0.045). On subspecialty analysis, VTE rates were highest for rhinology (0.013), followed by otology (0.010), head and neck (0.010), FPRS (0.006), comprehensive (0.004), sleep surgery (0.003), and laryngology (0.002). There was no correlation between chemoprophylaxis rates and either VTE or bleeding. Risk factors identified included prolonged procedure duration, free flap, lower extremity donor sites, and lumbar drain, among others. VTE rates in OHNS are overall low but may be further optimized. Development of an OHNS specialty-specific chemoprophylaxis guideline may improve perioperative risk stratification and reduce morbidity and mortality from VTE.