Use of the 2005 Caprini Risk Assessment Model for Predicting Perioperative Microthrombotic Risk in Patients Undergoing Free Tissue Transfer for Lower Limb Salvage
Michael V. DeFazio, M.D., Francis D. Graziano, B.S., Elizabeth Moroni, MHSA, Chrisovalantis Lakhiani, M.D., Eshetu Tefera, MS, Christopher E. Attinger, M.D., Karen K. Evans, M.D..
Medstar Georgetown University Hospital, Washington, DC, USA.
PURPOSE: The goal of this study was to evaluate the utility of the 2005 Caprini Risk Assessment Model (RAM) for predicting perioperative microvascular thrombosis among patients undergoing free tissue transfer for lower limb salvage.
METHODS: Between May 2011 and April 2017, 120 patients underwent microsurgical lower extremity reconstruction by the senior author (K.K.E.). Caprini scores were calculated and used to stratify patients into low (score </= 4 points), moderate (score 5 to 7 points), and high-risk (score, >/= 8 points) cohorts. The relationship between Caprini-risk category and the development of perioperative microvascular thrombosis, flap success, and limb salvage was examined through logistic regression analysis.
RESULTS: Of the patients included in this study, 49 (41%) were categorized as low-risk, 42 (35%) as moderate-risk, and 29 (24%) as high-risk patients. There were no significant differences in overall rates of flap success (p=0.15) or limb salvage (p=0.34) between cohorts. Compared to low-risk patients, those in the high-risk cohort were more likely to experience postoperative microthrombotic complications (OR, 6.1; p=0.034). Rates of intraoperative thrombosis were statistically similar among cohorts; however, the odds of developing an intraoperative event increased by 20% with every unit increase in Caprini score above 0 (p=0.035). On regression analysis, high Caprini-risk stratification was the only significant predictor of perioperative microthrombotic complications (OR, 5.1; p=0.013). No factors were significantly associated with flap success or ultimate limb salvage.
CONCLUSION: These data support the utility of the 2005 Caprini RAM as an adjunct for predicting perioperative microthrombotic complications following microsurgical lower extremity reconstruction.
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