The Influence of Perioperative Enoxaparin on Bleeding After TORS Oropharyngectomy

Abstract Objective: Perioperative enoxaparin is often avoided in patients undergoing trans-oral robotic (TORS) oropharyngectomy. Our goal was to quantify the risk of postoperative hemorrhage (POH) in patients receiving enoxaparin after TORS oropharyngectomy. Study Design: Retrospective database cohort study. Setting: 76 separate healthcare organizations. Methods: The TriNetX electronic database was queried for patients with OPSCC who underwent TORS oropharyngectomy. Propensity-score matching was used to create two cohorts, one receiving and one not receiving perioperative enoxaparin. Outcome measures were the POH rate within 7 days of surgery (“primary”) and POH rate within 7-30 days of surgery (“secondary”). Results: 973 patients undergoing TORS for OPSCC were identified, 362 of which received perioperative enoxaparin. One-to-one propensity score matching resulted in 276 patients per cohort. After matching, the primary POH rates between patients receiving and not receiving enoxaparin were 5.43% vs. 3.62% (OR 1.529, 95% CI 0.675 to 3.465). The secondary POH rates between those receiving and not receiving enoxaparin were 6.88% vs. 3.62% (OR 1.967, 95% CI 0.897 to 4.310). The number needed to harm (NNH) with perioperative enoxaparin use for primary and secondary POH after TORS was 55 and 30, respectively. Conclusion: While not statistically significant, the use of perioperative enoxaparin after TORS is associated with increased odds of POH with a NNH of 55 and 30 for primary and secondary POH. For patients undergoing TORS, enoxaparin use requires careful weighing of the risks and benefits.