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Assessment of Postoperative Venous Thromboembolism Risk in Plastic Surgery Patients Using the 2005 and 2010 Caprini Risk Score

Pannucci, Christopher J. M.D., M.S.; Barta, Ruth J. M.D.; Portschy, Pamela R. M.D.; Dreszer, George M.D., M.S.; Hoxworth, Ronald E. M.D.; Kalliainen, Loree K. M.D.; Wilkins, Edwin G. M.D., M.S.

Plastic & Reconstructive Surgery: August 2012 - Volume 130 - Issue 2 - p 343–353
doi: 10.1097/PRS.0b013e3182589e49
Reconstructive: Trunk: Outcomes Article
Video Discussion

Background: Venous thromboembolism is an important patient safety issue. The authors sought to compare the predictive capacity of the 2005 and 2010 Caprini Risk Assessment Models for perioperative venous thromboembolism risk.

Methods: The authors performed a retrospective, observational, crossover study using an established surgical outcomes database. A total of 3334 adult plastic surgery patients were identified. Patients were risk-stratified using both the 2005 and 2010 Caprini Risk Assessment Models. Each patient served as his or her own control, resulting in precise matching for identified and unidentified confounders. The outcome of interest was 60-day, symptomatic venous thromboembolism. The predictive capacities of the 2005 and 2010 Caprini risk scores were compared.

Results: Use of the 2010 Caprini Risk Assessment Model resulted in a systematic increase in the aggregate risk score. The median 2010 Caprini score was significantly higher than the median 2005 Caprini score (6 versus 5, p < 0.001). When compared with the 2010 model, the 2005 Caprini Risk Assessment Model was able to better separate the lowest and highest risk patients from one another. Patients classified as “super-high” risk (Caprini score >8) using the 2005 Caprini Risk Assessment Model were significantly more likely to have a 60-day venous thromboembolism event when compared with patients classified as super-high risk using the 2010 guidelines (5.85 percent versus 2.52 percent, p = 0.021).

Conclusions: When compared with the 2010 Caprini Risk Assessment Model, the 2005 Caprini Risk Assessment Model provides superior risk stratification. The 2005 Caprini Risk Assessment Model is the more appropriate method to risk-stratify plastic surgery patients for perioperative venous thromboembolism risk.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

VIDEO DISCUSSION BY CAROLYN L. KERRIGAN, M.D., IS AVAILABLE ONLINE FOR THIS ARTICLE.

Ann Arbor, Mich.; St. Paul, Minn.; and Dallas, Texas

From the Section of Plastic Surgery, University of Michigan; the Department of Plastic and Hand Surgery, Regions Hospital; and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication January 8, 2012; accepted February 8, 2012.

Presented at the 24th Annual Meeting of the American Venous Forum, in Orlando, Florida, February 8 through 11, 2012, and the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.

The Venous Thromboembolism Prevention Study was funded by THE PLASTIC SURGERY FOUNDATION.

Christopher J. Pannucci, M.D., M.S.; Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, Box 0340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109, cpannucc@umich.edu

©2012American Society of Plastic Surgeons