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Assessing Post-Operative Venous Thromboembolism Risk in Plastic Surgery Patients: A Head to Head Comparison of the 2005 and 2010 Caprini Risk Score
Christopher J. Pannucci, MD1, Ruth J. Barta, MD2, Pamela R. Portschy, MD2, George Dreszer, MD2, Ronald E. Hoxworth, MD3, Loree K. Kalliainen, MD2, Edwin G. Wilkins, MD MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Regions Hospital, Minneapolis, MN, USA, 3University of Texas-Southwestern, Dallas, TX, USA.

PURPOSE:
The 2005 Caprini Risk Assessment Model (RAM) is a weighted risk stratification tool that has previously been validated to predict 60-day venous thromboembolism (VTE) risk in plastic surgery patients. The 2010 Caprini RAM proposed notable alterations in risk factor weighting for operative time, body mass index, and cancer, and added superficial venous thrombophlebitis as a new risk factor. However, the recently published 2010 Caprini RAM has not previously been validated. The objective of this study was to compare risk scores derived from the 2005 and 2010 Caprini RAM and examine their ability to predict 60-day VTE risk.
METHODS:
The Venous Thromboembolism Prevention Study (VTEPS) was conducted over a three-year period at four tertiary care facilities. The VTEPS database contains data for peri-operative risk factors and 60-day VTE events. We performed a matched observational cohort study using the existing VTEPS database. Individual patients were risk-stratified using both the 2005 and 2010 Caprini RAMs. Each patient served as their own control, resulting in perfect matching for identified and non-identified confounders. Differences in VTE rate by stratified risk score were examined using Pearson’s chi-square test.
RESULTS:
The VTEPS database contained data for 3,334 patients. When compared to 2005 Caprini scores, 2010 Caprini scores were lower in 17.6% of patients, unchanged in 23.3%, and higher in 59.2% (Figure 1). Using the 2005 Caprini score, 6% of patients were considered “super-high” risk (Caprini scores of >8). Among this group, 60-day VTE rate was 5.85%. Using the 2010 Caprini scores, the number of patients risk-stratified as “super-high” risk increased three-fold to 19% of all patients. Observed VTE rates among this group decreased to 2.52% due to increased number of patients in the denominator without a corresponding increase in number of observed VTE events. Patients classified as “super-high” risk (Caprini score >8) using the 2005 Caprini RAM were significantly more likely to have a 60-day VTE event when compared to patients classified as “super-high” risk using the 2010 guidelines (5.85% vs. 2.52%, P=.021) (Figure 2).
CONCLUSION:
When compared to the 2010 Caprini RAM, the 2005 Caprini RAM provides superior risk stratification. The 2005 Caprini RAM should be used to risk-stratify plastic surgery patients and guide prophylaxis decisions.


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