Implementation of a Novel VTE Risk Assessment and Prophylaxis Strategy for Otolaryngology Surgery

ABSTRACT

Objective

To evaluate the feasibility, process adherence, and clinical outcomes associated with department‐wide implementation of simplified venous thromboembolism (VTE) risk assessment models (RAM) for inpatient and ambulatory otolaryngology surgical patients.

Methods

A mixed prospective and retrospective quality improvement initiative was conducted across two tertiary academic medical centers, including all scheduled adult otolaryngology surgical procedures from January 3, 2025, to November 20, 2025. Inpatient admissions were risk stratified using the COBRA score and ambulatory procedures using the Pannucci‐NSQIP score; inpatient risk stratifications were shared with surgeons. High VTE risk was defined as COBRA ≥ 4 for inpatients and Pannucci‐NSQIP ≥ 4 for ambulatory cases. Pharmacologic prophylaxis beginning on postoperative Day 1 was recommended for high‐risk inpatients. Process measures included adherence to prophylaxis guidance and documented rationales for deviation. Outcome measures included 30‐day VTE and hemorrhage events.

Results

A total of 3854 consecutive adult procedures were included (608 inpatient, 3246 ambulatory). 65% of inpatients and 14% of ambulatory cases were classified as high risk. Among high‐risk inpatients with length of stay ≥ 2 days, VTE occurred in 2.5% of patients receiving chemoprophylaxis on POD1 compared with 4.7% of those not receiving POD1 prophylaxis. No VTE events occurred in low‐risk inpatients, high‐risk inpatients discharged on POD1, or high‐risk ambulatory patients. Hemorrhage rates were similar across prophylaxis groups (3.2%–4.1%). Overall VTE rates were 1.8% for inpatients and 0.1% for ambulatory procedures.

Conclusion

The simplified COBRA and Pannucci‐NSQIP RAMs provide a feasible and potentially scalable framework for integrating VTE risk stratification into routine otolaryngology practice.

Level of Evidence

3.

We evaluated the systematic implementation of simplified VTE risk assessment models (i.e., COBRA for inpatient procedures and Pannucci‐NSQIP for outpatient procedures) at two large tertiary academic centers for 11 months across 3854 consecutive ENT procedures. Among high‐risk inpatients with longer hospital stays, initiation of chemoprophylaxis on postoperative Day 1 was associated with a lower observed rate of VTE without an increase in hemorrhagic complications. Together, our findings support tailoring pharmacologic VTE prophylaxis to patient risk, and further validate the practice of avoiding of chemoprophylaxis in low‐risk and ambulatory otolaryngology patients.

1. Introduction

Venous thromboembolic events (VTE) are a leading cause of increased postoperative morbidity, hospital length of stay, and healthcare costs [1]. Among otolaryngologic procedures, the 30‐day risk of VTE has been reported from 0.4% to 2.4% overall, though rates vary widely by subspecialty and procedure type [2, 3]. In particular, patients undergoing complex head and neck oncologic surgery, airway procedures, or prolonged inpatient admissions can carry VTE risks ten times higher than other routine outpatient procedures [2, 3].

While national guidelines recommend routine VTE risk stratification using validated tools such as the 2005 Caprini Risk Assessment Model, implementation in many subspecialties, including otolaryngology, remains inconsistent due to the model's complexity and practical challenges of collecting upwards of forty variables for each patient [4]. Clinical decision‐making is further complicated by concerns regarding postoperative hemorrhage, as bleeding events in head and neck and airway surgery may carry disproportionate consequences, including airway compromise or revision surgery [2]. Together, these factors have contributed to substantial heterogeneity in practice patterns and ongoing uncertainty regarding the optimal use of pharmacologic VTE prophylaxis for otolaryngologic procedures.

More recently, simplified risk assessment models (RAM), such as the COBRA and Pannucci‐NSQIP, have been developed to address these challenges in both an inpatient and ambulatory surgical setting. The COBRA score was designed as a five‐parameter RAM for surgical admissions, incorporating the patient's age, BMI, active cancer, Black/African American race, and American Society of Anesthesiologists (ASA) score [5]. The Pannucci‐NSQIP was designed as an eight‐parameter RAM for ambulatory procedures, though three are typically not relevant as they assess for arthroscopic surgery or vascular surgery; the remaining five relevant factors include age, BMI, operative duration, active cancer, and pregnancy status [6]. Both the COBRA and Pannucci‐NSQIP models have demonstrated correlation with high Caprini scores, including a recent retrospective assessment in otolaryngology patients, suggesting potential utility in this population and warranting further evaluation in a real‐world setting [4].

In this study, we implemented a department‐wide quality improvement (QI) initiative across two tertiary academic centers to systematically calculate VTE risk for all scheduled adult otolaryngology surgical patients using the COBRA score for inpatient admissions and the Pannucci‐NSQIP score for ambulatory procedures. We sought to evaluate the feasibility of implementing both simplified RAMs at scale, characterize VTE risk across otolaryngology subspecialties, assess adherence to prophylaxis guidance, and examine postoperative VTE and hemorrhage outcomes in both inpatient and ambulatory settings.

2. Methods

2.1. Overview

This project was conducted as a mixed prospective and retrospective QI initiative, designed to implement and evaluate systematic venous thromboembolism (VTE) risk assessment and prophylaxis guidance within a bicampus otolaryngology residency program at two large tertiary academic medical centers. The prospective component focused on real‐time risk stratification for all procedures and communication of guidance for inpatient procedures, while the retrospective component evaluated postoperative outcomes for the same patients across both inpatient and ambulatory settings. The initiative was conducted using routinely collected clinical data and aligned with institutional policies governing QI initiatives.

2.2. Patient Population and Risk Stratification

All scheduled adult inpatient and ambulatory otolaryngology procedures performed between January 03, 2025 and November 20, 2025 were eligible for inclusion. Each procedural encounter was treated as a distinct case. Pediatric cases and cases that were scheduled but ultimately canceled on retrospective review were excluded.

For inpatient surgical admissions, VTE risk stratification was assessed using the COBRA RAM, which incorporates five routinely available clinical variables: age > 60 years, BMI > 30 kg/m², active cancer, Black or African American race, and an ASA score. Each of the first four variables contributes one point when present, while ASA class is added at face value, yielding a score range from 1 to 9. Prior studies demonstrated both a clinically meaningful postoperative 2.4% + VTE risk with Caprini scores of 7, and the correlation between a Caprini score of 7 and a COBRA score of 4 among otolaryngology patients [3, 4]. The decision was thus made to define high VTE risk as COBRA score greater than or equal to 4, while scores less than 4 were categorized as low risk.

For ambulatory procedures, VTE risk was assessed using the Pannucci‐NSQIP RAM, which was specifically developed to identify patients at increased risk for postoperative VTE following outpatient surgery. This model incorporates five relevant factors to otolaryngologic procedures, including age, BMI, cancer status, operative duration, and pregnancy status. Patients were stratified into high‐ and low‐risk categories using established thresholds corresponding to elevated 30‐day VTE risk. High VTE risk was defined as a Pannucci‐NSQIP score ≥ 4, based on prior evidence demonstrating that this threshold corresponds to a Caprini score of 7 [4].

2.3. Defining Prophylaxis Regimen

All inpatient surgical patients were recommended to receive mechanical VTE prophylaxis in accordance with institutional standards of care [7]. For patients classified as high risk based on a COBRA score of 4 or greater, additional pharmacologic VTE prophylaxis was recommended to start on postoperative Day 1 and to continue until a patient was considered ambulatory or discharged, consistent with prior standard guideline principles for otolaryngologic procedures [7]. Pharmacologic prophylaxis was defined as administration of subcutaneous unfractionated heparin, low‐molecular‐weight heparin (enoxaparin), or continuation of pre‐operative anticoagulation (e.g., apixaban or rivaroxaban). Patients discharged on postoperative Day 1 were considered ambulatory, and pharmacologic prophylaxis was therefore not indicated in this group regardless of VTE risk classification. For patients classified as low risk by the COBRA score, pharmacologic prophylaxis was not recommended.

Ambulatory procedures were similarly stratified into high‐ and low‐risk categories using the Pannucci‐NSQIP score. However, pharmacologic VTE prophylaxis was not recommended for any ambulatory patients, irrespective of risk category, given the expectation of immediate postoperative ambulation and the lack of evidence supporting routine chemoprophylaxis in outpatient otolaryngology surgery [7].

2.4. Quality Improvement Implementation

As part of the QI intervention, all scheduled surgical cases were compiled on a weekly rolling basis. Each case was categorized as inpatient or ambulatory, and the appropriate VTE RAM was applied prospectively using routinely available clinical and procedural data. For inpatient procedures, weekly email summaries with VTE risk stratification and a reference to published chemoprophylaxis guidance were shared with attending surgeons and resident teams [7]. To preserve clinical autonomy and acknowledge the multifactorial considerations inherent to anticoagulation decisions, the emails were explicitly framed as guidance rather than prescriptive recommendations. The final decision to initiate or withhold pharmacologic prophylaxis was intentionally deferred to the attending surgeon's clinical judgment. Ambulatory procedures were not included in the weekly email communications; this decision reflected the institutional precedent against routine chemoprophylaxis in ambulatory otolaryngology surgery.

2.5. Measures and Evaluation

Evaluation of the QI initiative incorporated descriptive characterization as well as process, outcome, and balancing measures. Descriptive measures characterized the study population by otolaryngology subspecialty and by surgical setting (inpatient versus ambulatory) to contextualize variation in baseline VTE risk.

Process measures focused on adherence to VTE prophylaxis guidance among inpatient procedures. For high‐risk patients, adherence was defined as initiation of pharmacologic prophylaxis beginning on postoperative Day 1. For low‐risk patients, adherence was defined as appropriate non‐prescription of pharmacologic prophylaxis. Compliance rates were calculated quarterly to assess temporal trends following implementation. For cases in which chemoprophylaxis decisions deviated from guidance, treating teams were asked to document the primary rationale, such as increased or severe bleeding risk, recent hematoma/hemorrhage, early ambulation, or cross‐service management.

Outcome measures included postoperative VTE and hemorrhage events occurring within 30 days of surgery. VTE events were defined as clinically diagnosed deep vein thrombosis or pulmonary embolism confirmed by ultrasound or cross‐sectional imaging. Hemorrhagic events were defined as postoperative hemorrhage, hematoma, or epistaxis related to the surgical site that did not self‐resolve and required clinical intervention, including medical/procedural management or return to the operating room. Hemorrhage was considered a balancing measure, reflecting potential unintended consequences of increased pharmacologic prophylaxis.

2.6. Statistical Analysis

Continuous variables are presented as means with standard deviations and were compared using two‐tailed Welch's t‐tests. Categorical variables are presented as proportions and were compared using chi‐square tests. Statistical significance was defined as a two‐sided p‐value less than 0.05. Given the QI nature of the initiative, the low absolute number of VTE events, and the emphasis on feasibility and safety, analyses were primarily descriptive and unadjusted.

3. Results

3.1. Patient and Procedure Characterization

A total of 3854 adult otolaryngology surgical cases were included during the study period, comprising 608 inpatient procedures (15.8%) and 3246 ambulatory procedures (84.2%). All scheduled adult cases were successfully captured and assigned a venous thromboembolism (VTE) risk score, demonstrating complete feasibility of systematic risk stratification across the department.

Among inpatient procedures, 65% (n = 400) were classified as high risk based on a COBRA score of 4 or greater (Figure 1). The proportion of high‐risk patients varied substantially by subspecialty (Table 1). Tracheostomy cases demonstrated the highest prevalence of high‐risk patients (97%), followed by head and neck surgery (73%), laryngology/direct laryngoscopy (64%), and rhinology (51%). Otology, sleep surgery, facial trauma, and facial plastic and reconstructive surgery (20%) demonstrated lower but clinically meaningful proportions of high‐risk inpatients. High‐risk inpatient procedures were associated with greater values across all COBRA subcomponents, reflecting the construct validity of the older age (mean 66.3 vs. 44.8 years, p < 0.001), higher BMI (27.6 vs. 24.9 kg/m², p < 0.001), higher prevalence of cancer (53.8% vs. 12.4%, p < 0.001), and greater medical comorbidity reflected by higher ASA class (mean 3.0 vs. 2.1, p < 0.001) (Table 2).

FIGURE 1.

Distribution of otolaryngologic inpatient procedures by COBRA score. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]

TABLE 1.

VTE risk of otolaryngology surgical patients by specialty.

Specialty	Inpatient procedures		Ambulatory procedures
	N	High risk	N	High risk
Tracheostomy	34	97%	—	—
H&N	325	73%	769	32%
Laryngology/DL	45	64%	541	16%
Rhinology	138	51%	977	5%
Otology	34	47%	336	5%
Sleep	14	36%	149	7%
Facial trauma	13	31%	25	0%
FPRS	5	20%	341	11%
General	—	—	108	4%
Total	608	65%	3246	14%

TABLE 2.

Characteristics of inpatient procedures with high versus low VTE risk.

	High risk	Low risk	p a
Demographics (N)	400	208
Age	66.3 (14.4)	44.8 (15.6)	< 0.001
% Female	48.2%	54.3%	0.156
BMI	27.6 (6.3)	24.9 (4.3)	< 0.001
COBRA score	4.8 (0.8)	2.5 (0.6)	< 0.001
Age > 60	75.6%	21.0%	< 0.001
BMI > 30	30.4%	9.0%	< 0.001
Cancer	53.8%	12.4%	< 0.001
Black	15.0%	4.3%	< 0.001
ASA	3.0 (0.6)	2.1 (0.5)	< 0.001

^a Continuous variables use two‐tailed Welch's t‐test; binary variables use a Chi‐square test.

Among ambulatory procedures, 14% (n = 454) were classified as high risk by the Pannucci‐NSQIP score (Figure 2). Head and neck surgery accounted for the largest proportion of high‐risk outpatient cases (32%), followed by laryngology (16%) and facial plastic and reconstructive surgery (11%). Rhinology (5%), otology (5%), sleep surgery (7%), facial trauma (0%), and general otolaryngology (4%) demonstrated low proportions of high‐risk ambulatory patients. High‐risk ambulatory patients were significantly older (mean 64.4 vs. 46.3 years, p < 0.001), had higher BMI (27.3 vs. 26.3 kg/m², p < 0.001), and were more likely to have active cancer (94.0% vs. 0.6%, p < 0.001) than low‐risk ambulatory patients (Table 3). Operative duration exceeding two hours was also more common among high‐risk ambulatory cases (62.1% vs. 55.3%, p = 0.010).

FIGURE 2.

Distribution of otolaryngologic ambulatory procedures by Pannucci‐NSQIP score. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]

TABLE 3.

Characteristics of ambulatory procedures with high versus low VTE risk.

	High risk	Low risk	p a
Demographics (N)	454	2792
Age	64.4 (14.0)	46.3 (17.8)	< 0.001
% Female	49.7%	50.5%	0.737
BMI	27.3 (6.5)	26.3 (5.3)	< 0.001
Pannucci score	8.7 (1.3)	2.6 (1.7)	< 0.001
Age score	2.6 (0.8)	1.4 (1.3)	< 0.001
BMI > 40	7.5%	1.8%	< 0.001
Operative duration > 2h	62.1%	55.3%	0.010
Cancer	94.0%	0.6%	< 0.001
Pregnant	0.7%	0.0%	< 0.001

^a Continuous variables use two‐tailed Welch's t‐test; binary variables use a Chi‐square test.

3.2. Process Measures: Adherence to Prophylaxis Guidance

Process evaluation focused on inpatient procedures with length of stay ≥ 2 days, as pharmacologic prophylaxis was not indicated for patients discharged on postoperative Day 1 and therefore presumed ambulatory. For high‐risk inpatients, adherence, defined as initiation of pharmacologic prophylaxis on postoperative Day 1, increased from 50.6% in Q1 to 57.8% in Q4 (Figure 3). For low‐risk inpatients, appropriate non‐prescription of pharmacologic prophylaxis remained consistently higher, increasing from 61.8% in Q1 to 66.7% in Q4. Among high‐risk inpatients who did not receive chemoprophylaxis, the most frequently documented rationale was that the patient was not primarily managed by the otolaryngology service (59%). Other factors included increased bleeding risk based on surgical factors (14%); recent postoperative hemorrhage/hematoma (5%); early ambulation (7%); and the remainder (14%) had no documented rationale. Among low‐risk inpatients who nevertheless did receive chemoprophylaxis, 78% were not primarily managed by the otolaryngology service, 8% involved free flap reconstruction (where initiation of chemoprophylaxis is standard in our institutional flap protocols), 4% restarted prior therapeutic anticoagulation, and 10% lacked a documented rationale.

FIGURE 3.

DVT prophylaxis compliance for otolaryngology inpatients with LOS ≥ 2 days. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]

3.3. Outcome Measures: VTE and Hemorrhage Events

Across all 608 inpatient procedures, 11 VTE events (1.8%) and 17 hemorrhagic events (2.8%) were identified within 30 days postoperatively (Table 4). All VTE events occurred among patients classified as high risk. No VTE events were observed in low‐risk inpatient procedures, regardless of prophylaxis status. Importantly, no VTE events occurred among high‐risk inpatients discharged on postoperative Day 1, supporting the classification of these patients as functionally ambulatory with low short‐term thromboembolic risk. Among high‐risk inpatients with length of stay greater than 1 day, VTE incidence differed by timing of chemoprophylaxis initiation. Patients who received pharmacologic prophylaxis beginning on postoperative Day 1 experienced a VTE rate of 2.5% (4/158), compared with 4.7% (7/148) among those who did not receive prophylaxis on postoperative Day 1. Although this difference did not reach statistical significance, it demonstrated a directionally lower VTE rate associated with early chemoprophylaxis. Among low‐risk inpatients, no VTE events were observed. Hemorrhagic rates among high‐risk inpatients were similar across prophylaxis groups, ranging from 3.2% to 4.1%, with no statistically meaningful increase associated with early initiation of chemoprophylaxis.

TABLE 4.

VTE and hemorrhagic event outcomes among otolaryngology inpatient procedures.

DVT risk	DVT prophylaxis	N	VTE	Hemorrhage
High	Started Post‐op Day 1	158	4 (2.5%)	6 (3.8%)
	Not Started Post‐op Day 1	148	7 (4.7%)	6 (4.1%)
	Discharged Post‐op Day 1	94	0 (0%)	3 (3.2%)
Low	Started Post‐op Day 1	46	0 (0%)	0 (0%)
Total	Not Started Post‐op Day 1	76	0 (0%)	2 (2.6%)
	Discharged Post‐op Day 1	86	0 (0%)	0 (0%)
	—	608	11 (1.8%)	17 (2.8%)

Among 3246 ambulatory procedures, VTE events were exceedingly uncommon, with three events (0.1%) identified within 30 days (Table 5). No VTE events occurred in high‐risk ambulatory patients, while all three events occurred in low‐risk outpatients. Hemorrhage rates among ambulatory procedures were low overall (1.0%), consisting primarily of epistaxis or post‐tonsillectomy hemorrhage (Table 5).

TABLE 5.

VTE and hemorrhagic event outcomes among otolaryngology ambulatory procedures.

DVT risk	N	VTE	Hemorrhage
High	454	0 (0%)	4 (0.9%)
Low	2792	3 (0.1%)	30 (1.1%)
Total	3246	3 (0.1%)	34 (1.0%)

4. Discussion

In this large, department‐wide QI initiative, we demonstrate that systematic venous thromboembolism (VTE) risk stratification is feasible and informative by using simplified RAMs across the full spectrum of otolaryngology surgical care. By prospectively applying the COBRA score to inpatient admissions and the Pannucci‐NSQIP score to ambulatory procedures, we successfully captured and stratified 100% of scheduled adult cases over an 11‐month period, encompassing more than 3800 consecutive surgical encounters. This level of comprehensive case capture highlights the practicality of implementing streamlined, low‐burden risk assessment tools at scale, addressing a key barrier that has historically limited adoption of more complex models, such as the Caprini score in otolaryngology practice.

The overall postoperative VTE rates observed in this cohort are consistent with prior literature describing VTE risk in otolaryngology. Across all inpatient procedures, the observed VTE rate was 1.8%, comparable to previously reported rates ranging from approximately 0.4%–2.4% depending on case mix and surgical complexity. Importantly, all VTE events occurred in patients classified as high risk, while no VTE events were observed among low‐risk inpatients or among high‐risk inpatients discharged on postoperative Day 1. These findings further support the construct and criterion validity of simplified risk stratification in otolaryngology and reinforce the concept that early ambulation and short length of stay substantially mitigate thromboembolic risk, even among patients with elevated baseline risk factors.

Among high‐risk inpatients with a length of stay greater than one day, early initiation of pharmacologic prophylaxis on postoperative day 1 was associated with a directionally lower rate of VTE compared with delayed or absent prophylaxis (2.5% vs. 4.7%). Although this difference did not reach statistical significance, likely due to the low absolute number of events, the magnitude and direction of effect are clinically meaningful and consistent with broader surgical literature supporting early prophylaxis in high‐risk populations. Importantly, this reduction was achieved without an associated increase in postoperative hemorrhagic events.

The ambulatory cohort further underscores the importance of tailoring prophylaxis strategies to surgical setting and functional mobility. Despite 14% of ambulatory procedures being classified as high risk by the Pannucci‐NSQIP score, no VTE events were observed in this group, and the overall ambulatory VTE rate was only 0.1%. These data strongly support the current practice of not routinely prescribing pharmacologic prophylaxis for ambulatory otolaryngology procedures, even among patients with elevated risk scores, provided early ambulation is achieved. Together with the inpatient findings, this reinforces a risk‐ and context‐dependent approach rather than a one‐size‐fits‐all prophylaxis strategy.

This study meaningfully expands the existing evidence base for VTE risk in otolaryngology. A 2018 systematic review identified a total of 4615 inpatient and ambulatory otolaryngology procedures reported across studies dating back to the 1970s [2]. By contributing data from 3854 additional consecutive patients, our study substantially increases the available data pool, making it one of the largest comprehensive evaluations of VTE risk and prophylaxis in otolaryngology to date. Unlike many prior studies limited to specific subspecialties or procedure types, this analysis spans an entire department, capturing real‐world heterogeneity in patient complexity, surgical indication, and perioperative management.

Our process measure analyses highlight both progress and persistent challenges in translating risk stratification into consistent clinical practice. Adherence to prophylaxis guidance among high‐risk inpatients improved over time but remained suboptimal, with approximately 40% of eligible patients not receiving chemoprophylaxis on postoperative Day 1. Review of documented rationales illustrates that non‐adherence was often driven by structural and contextual factors rather than simple oversight. Nearly half of high‐risk patients who did not receive prophylaxis were not primarily managed by the otolaryngology service, limiting the specialty's ability to influence anticoagulation decisions. Other common rationales, including concern for postoperative bleeding or recent hemorrhage, reflect appropriate clinical judgment in complex surgical scenarios. These findings underscore the inherent difficulty of enforcing protocolized care in a heterogeneous, multidisciplinary inpatient population and highlight the importance of framing risk assessment outputs as guidance rather than rigid mandates.

Several limitations are important to consider in this study. First, this was a non‐randomized QI initiative, and causality between prophylaxis timing and VTE outcomes cannot be definitively established. The low absolute number of VTE events limited statistical power, precluding definitive conclusions regarding efficacy despite directionally important findings. Second, detailed reasons for prophylaxis decisions were not always available, particularly for patients managed primarily by non‐ENT services, limiting insight into cross‐disciplinary decision‐making. Third, we lacked pre‐intervention data, making it difficult to isolate the specific impact of the intervention itself. However, Caprini‐based risk stratification was not routinely used at our institution prior to this initiative, and the comprehensive characterization of VTE risk and outcomes remains valuable regardless of intervention effect. Finally, subspecialty‐specific analyses were beyond the scope of this study but may reveal important nuances warranting future investigation.

Despite these limitations, this study demonstrates the feasibility and potential value of implementing simplified VTE risk assessment at scale within otolaryngology. Most of the COBRA and Pannucci‐NSQIP factors are easily accessible data fields (e.g., age, BMI, race, cancer, pregnancy status, ASA) with physician input required only for defining whether surgery includes arthroscopic/vascular involvement that is typically excluded for otolaryngologic procedures. Future efforts should focus on integration of risk assessment tools into the electronic health record to enable automatic risk stratification and decision support at the point of care. Such systems could facilitate consistent, multidisciplinary application of prophylaxis guidance across all surgical specialties while preserving clinician autonomy and allowing for patient‐specific nuance.

5. Conclusion

Systematic use of simplified VTE RAMs like the COBRA and Pannucci‐NSQIP was feasible across a large adult otolaryngology surgical population and enabled characterization of VTE risk and outcomes across all patients. Among high‐risk inpatients with longer hospital stays, initiation of chemoprophylaxis on postoperative Day 1 was associated with a lower observed rate of VTE without an increase in hemorrhagic complications. Together, our findings support tailoring pharmacologic VTE prophylaxis to patient risk, and further validate the practice of avoiding chemoprophylaxis in low‐risk and ambulatory otolaryngology patients.

Funding

The authors have nothing to report.

Disclosure

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Lu R. J., Berman H., Boonpongmanee I., Persons B., Kim A. H.‐O., and Sclafani A., “Implementation of a Novel VTE Risk Assessment and Prophylaxis Strategy for Otolaryngology Surgery,” The Laryngoscope 136, no. 8 (2026): 3432–3438, 10.1002/lary.70484.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.