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British Journal of Oral and Maxillofacial Surgery 52 (2014) 401–404
Symptomatic venous thromboembolism in orthognathic surgery and distraction osteogenesis: a retrospective cohort study of 4127 patients Charlotte R.A. Verlinden ∗ , Dirk B. Tuinzing, Tymour Forouzanfar VU University Medical Center, Department of Oral and Maxillofacial Surgery/ Oral Pathology and Academic Centre of Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands Accepted 6 March 2014 Available online 31 March 2014
Abstract Venous thromboembolism is a common postoperative complication, and orthopaedic procedures are particularly at risk. We designed a retrospective, single centre, observational, cohort study of 4127 patients (mean (SD) age 27 (11) years) who had elective orthognathic operations or distraction osteogenesis between January 1970 and February 2012 at the VU University Medical Centre, Amsterdam, to investigate the incidence in this group over the 42-year period, 2 patients developed symptomatic venous thromboembolism (1 woman had a deep vein thrombosis (DVT) and 1 man had a DVT and pulmonary embolus) postoperatively. In relatively young patients with low to moderate risk factors and short hospital stay this type of operation is associated with a particularly low risk of developing thrombosis. It could be advisable to limit the use of thromboprophylaxis to patients at high risk or according to hospital guidelines. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Oral and maxillofacial surgery; Orthognathic surgery; Distraction osteogenesis; Pulmonary embolism; Thrombosis; Deep vein thrombosis; Venous thromboembolism (VTE)
Introduction Venous thromboembolism comprises deep venous thrombosis (DVT) and pulmonary embolism (PE), and is a common complication after operation, trauma, and prolonged immobilisation. It can lead to further morbidity that comprises post-thrombotic syndrome, pulmonary hypertension and mortality. 1–5 It is often asymptomatic and misdiagnosed, and can therefore cause appreciable morbidity and mortality. Cohen et al. designed an epidemiological model to estimate the number of community and hospital-related incidents and recurrence of
∗
Corresponding author. Tel.: +31 20 444 1023; fax: +31 20 4441024. E-mail addresses: [email protected], [email protected] (C.R.A. Verlinden).
non-fatal venous thromboses and thrombosis-related deaths in Europe. According to the model an estimated 465 715 cases of DVT, 295 982 cases of PE, and 370 012 related deaths occur yearly.5 This makes it one of the major health issues in the European Union.5,6 The reports on incidence vary and are influenced by factors as age, race, sex, necropsy evidence, and recurrent episodes.6 Strong clinical risk factors associated with thromboembolic disease are orthopaedic trauma (hip or leg), major orthopaedic operations (hip or knee replacement), major general surgical operations, major trauma, and injury to the spinal cord. Age (>40 years), obesity, recurrent disease, cancer, prolonged immobilisation (>5 days) and hormone replacement are moderate risk factors (Table 1).1,4,13 Prophylaxis against thromboembolism is required in many cases, particularly orthopaedics. Lapidus et al. studied a total of 46 796 procedures and found 514 cases of venous
http://dx.doi.org/10.1016/j.bjoms.2014.03.006 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
402
C.R.A. Verlinden et al. / British Journal of Oral and Maxillofacial Surgery 52 (2014) 401–404
Table 1 Risks of venous thromboembolism in surgical patients without prophylaxis, according to Geerts et al.1 Data are given as percentage risk. Level of risk
DVT (calf)
DVT (proximal)
PE (clinical)
PE (fatal)
Low risk: Minor operation in patients
British Journal of Oral and Maxillofacial Surgery 52 (2014) 401–404
Symptomatic venous thromboembolism in orthognathic surgery and distraction osteogenesis: a retrospective cohort study of 4127 patients Charlotte R.A. Verlinden ∗ , Dirk B. Tuinzing, Tymour Forouzanfar VU University Medical Center, Department of Oral and Maxillofacial Surgery/ Oral Pathology and Academic Centre of Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands Accepted 6 March 2014 Available online 31 March 2014
Abstract Venous thromboembolism is a common postoperative complication, and orthopaedic procedures are particularly at risk. We designed a retrospective, single centre, observational, cohort study of 4127 patients (mean (SD) age 27 (11) years) who had elective orthognathic operations or distraction osteogenesis between January 1970 and February 2012 at the VU University Medical Centre, Amsterdam, to investigate the incidence in this group over the 42-year period, 2 patients developed symptomatic venous thromboembolism (1 woman had a deep vein thrombosis (DVT) and 1 man had a DVT and pulmonary embolus) postoperatively. In relatively young patients with low to moderate risk factors and short hospital stay this type of operation is associated with a particularly low risk of developing thrombosis. It could be advisable to limit the use of thromboprophylaxis to patients at high risk or according to hospital guidelines. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Oral and maxillofacial surgery; Orthognathic surgery; Distraction osteogenesis; Pulmonary embolism; Thrombosis; Deep vein thrombosis; Venous thromboembolism (VTE)
Introduction Venous thromboembolism comprises deep venous thrombosis (DVT) and pulmonary embolism (PE), and is a common complication after operation, trauma, and prolonged immobilisation. It can lead to further morbidity that comprises post-thrombotic syndrome, pulmonary hypertension and mortality. 1–5 It is often asymptomatic and misdiagnosed, and can therefore cause appreciable morbidity and mortality. Cohen et al. designed an epidemiological model to estimate the number of community and hospital-related incidents and recurrence of
∗
Corresponding author. Tel.: +31 20 444 1023; fax: +31 20 4441024. E-mail addresses: [email protected], [email protected] (C.R.A. Verlinden).
non-fatal venous thromboses and thrombosis-related deaths in Europe. According to the model an estimated 465 715 cases of DVT, 295 982 cases of PE, and 370 012 related deaths occur yearly.5 This makes it one of the major health issues in the European Union.5,6 The reports on incidence vary and are influenced by factors as age, race, sex, necropsy evidence, and recurrent episodes.6 Strong clinical risk factors associated with thromboembolic disease are orthopaedic trauma (hip or leg), major orthopaedic operations (hip or knee replacement), major general surgical operations, major trauma, and injury to the spinal cord. Age (>40 years), obesity, recurrent disease, cancer, prolonged immobilisation (>5 days) and hormone replacement are moderate risk factors (Table 1).1,4,13 Prophylaxis against thromboembolism is required in many cases, particularly orthopaedics. Lapidus et al. studied a total of 46 796 procedures and found 514 cases of venous
http://dx.doi.org/10.1016/j.bjoms.2014.03.006 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
402
C.R.A. Verlinden et al. / British Journal of Oral and Maxillofacial Surgery 52 (2014) 401–404
Table 1 Risks of venous thromboembolism in surgical patients without prophylaxis, according to Geerts et al.1 Data are given as percentage risk. Level of risk
DVT (calf)
DVT (proximal)
PE (clinical)
PE (fatal)
Low risk: Minor operation in patients
