An Examination Of Venous Thromboembolism Risk Using Caprini Scores Amongst Outpatient Aesthetic Surgery Patients Who Receive No Chemoprophylaxis
Michael Trostler, MD1, Pierce Jannsen, BS1, Christopher Pannucci, MD2, Sami Khan, MD1.
1Stony Brook University, Stony Brook, NY, USA, 2University of Utah, Salt Lake City, UT, USA.
PURPOSE: Venous Thromboembolism (VTE) is a potentially lethal event with an increased risk after surgical procedures. The Caprini Risk Assessment Model (RAM) is a validated and widely utilized tool for VTE risk stratification and prophylaxis. The risk of VTE varies by procedure and individual patient factors. Currently, our best tools are validated scoring systems that stratify patients into treatment groups based on risk, but many surgeons still make their own judgement due to concerns of bleeding. While the American Society of Plastic Surgeons(ASPS) and the American Association of Plastic Surgeons(AAPS) recommend individual VTE risk stratification, there is a paucity of research focusing on the outpatient or aesthetic surgery populations that demonstrates that Caprini scores are effective. The goal of the study is to assess the risk of VTE in ambulatory aesthetic surgery patients based on Caprini risk stratification.
METHODS: A retrospective review of 2,595 patients undergoing ambulatory aesthetic surgery between October 2000 and January 2005 was performed. Caprini scores were calculated for each patient and then stratified into risk categories: (1-2), (3-4), (5-6), (7-8). All patients received general anesthesia and sequential compression devices for mechanical prophylaxis, and no patient received chemoprophylaxis. The incidence of hematomas, reoperations, and VTE events, which were confirmed by radiology, were evaluated.
RESULTS: Caprini risk stratification was as follows: 30.21% (1-2), 59.46% (3-4), 9.79% (5-6), 0.539% (7-8) and 0% (>8). Mean follow up time was 10.8 months (1-105 months). The overall incidence of hematomas was 2.8%(73/2595) with 57.5% (42/73) requiring reoperation for hematoma evacuation. The incidence of re-operative hematoma was 1.6%. The postoperative incidence of VTE was 0.077% (2/2595). These two VTE events included one pulmonary embolism diagnosed by V/Q scan at postoperative day 22, this patient had a Caprini score of 4, underwent an abdominoplasty. The second event was an ileofemoral deep vein thrombosis (DVT) confirmed on duplex ultrasound on post-operative day 1 after multiple small procedures with a facelift. This patient had a risk score of 5.
CONCLUSIONS: The ambulatory aesthetic surgery population who have procedures under general anesthesia prophylaxis is at a very low baseline risk for VTE, with only 0.08% of patients, in this large cohort treated with only mechanical prophylaxis, experiencing a VTE event. Only a small proportion (0.5%) of our overall population falls into the Caprini score >7, known to be the highest risk among the inpatient population. Given the low number of VTE outcome events in this cohort of over 2,500 patients we can only say that the predictive value of the 2005 Caprini score for VTE events requires further study.
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