Application of the Caprini Risk Assessment Model in Evaluation of Non-Venous Thromboembolism Complications in Plastic and Reconstructive Surgery Patients
Jeong, Haneol S.
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GOALS/PURPOSE: The Caprini Risk Assessment Model (RAM) is an ordinal scoring tool used to quantify and categorize a patient's risk for venous thromboembolism in the post-surgery setting. However, there has been no similar exploration into predictive associations of this score with the other potential complications of surgical procedures. This is surprising because the full list of variables that comprise an individual Caprini score involve a host of systemic factors that involve multiple organ systems. This study investigates whether Caprini scores can be applied to non-VTE complications. METHODS/TECHNIQUE: Authors undertook a retrospective chart review of 1598 encounters for a series of complex reconstructive and body-contouring operations at an academic medical institution. Input variables included Caprini score components, patient co-morbidities, and prophylactic use. Output variables were postoperative complications. Tests for proportions were performed on percentile data. Non-percentile data was treated with comparison of means (t-test). Odds ratios for complications were calculated for stratified risk groups and compared. RESULTS/COMPLICATIONS: The overall complication rate was 28.03%. DVT incidence was 1.50%. In comparing complication vs. complication-free patients, age, BMI, operation time, hypertension, diabetes, renal disease, and cancer were statistically significant. For DVT versus DVT-free patients, sex, BMI, operation time, smoking status, diabetes, hypertension, and prior DVT were significant. Increasing Caprini scores are associated with increasing odds ratios (OR) for dehiscence (1.73, p = 0.028), infection (2.04, p = 0.0003), seroma (1.52, p = .045), hematoma (2.12, p = 0.050), and necrosis (2.83, p = 0.0004) with a corresponding overall OR increase of 1.69 (p < 0.0001). These odds ratios parallel similar increases in the baseline occurrence rates for the noted complications. CONCLUSIONS: The data demonstrates that Caprini scores can be applied preoperatively to categorize a patient's risk of developing multiple non-VTE complications. Patients in the higher risk categories will be at an increased risk of suffering from wound dehiscence, infection, seroma, hematoma, and necrosis. Considering these potential complications as a single group, a high-risk patient has a 69% increased odds of suffering at least one problem compared with low-risk individuals. Unfortunately, few preoperative steps can be taken to directly address the complications that the Caprini model is predictive for. However, these results can help physicians better understand which complications to keep watch for most rigorously during postoperative monitoring. In addition, the data can guide conservations with patients during initial preoperative consultations.