Venous Thromboembolism Risk Across Otolaryngology-Head and Neck Surgery Subspecialties: A National Database Analysis.

OBJECTIVE: To assess venous thromboembolism (VTE) rates across the spectrum of otolaryngology-head and neck surgery (OHNS) between and within subspecialties. STUDY DESIGN: Retrospective national database study. SETTING: The Atropos database, a national aggregated cohort of 66 million patients across the United States, was queried for patients who underwent OHNS surgery. METHODS: Adult patients who had at least one Current Procedural Terminology code for OHNS procedures between 2015 and 2025 were assessed for the outcome of 90-day VTE. Postoperative VTE rates were compared within and between OHNS subspecialties. Risk factors for VTE outcomes were assessed using univariable analysis. RESULTS: 277,187 patients (mean age 58.6 ± 18.7 years, 46.8% male) who had OHNS surgery were included. Postoperative VTE occurred in 1735 (0.63%) patients. VTE rates were highest in head and neck (1.3%), followed by laryngology (1.0%), rhinology (0.6%), facial plastic and reconstructive surgery (0.5%), otology (0.5%), and sleep surgery (0.3%). Differential VTE rates for procedural groups within each subspecialty were observed. The procedural groups with the highest VTE rates were free tissue transfer (6.1%), lateral skull base surgeries (4.4%), cricopharyngeal myotomies (3.1%), and anterior skull base surgeries (3.1%). Prior VTE (OR 12.3 [95% confidence interval, 11.2-13.4]) was the covariate with the highest risk for postoperative VTE. CONCLUSION: Although the overall VTE rate was low (0.6%), intersubspecialty and intrasubspecialty variation in VTE rates were observed, and a subset of OHNS procedures had substantially higher VTE risk. These findings may inform surgeon decision-making regarding chemoprophylaxis.