title: Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients.
abstract: BACKGROUND
  The Venous Thromboembolism Prevention Study (VTEPS) Network is a consortium of 5 tertiary referral centers established to examine venous thromboembolism (VTE) in plastic surgery patients. We report our midterm analyses of the study's control group to evaluate the incidence of VTE in patients who receive no chemoprophylaxis, and validate the Caprini Risk Assessment Model (RAM) in plastic surgery patients.
  
  
  METHODS
  Medical record review was performed at VTEPS centers for all eligible plastic surgery patients between March 2006 and June 2009. Inclusion criteria were Caprini score ≥3, surgery under general anesthesia, and postoperative hospital admission. Patients who received chemoprophylaxis were excluded. Dependent variables included symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) within the first 60 postoperative days and time to DVT or PE.
  
  
  RESULTS
  We identified 1,126 historic control patients. The overall VTE incidence was 1.69%. Approximately 1 in 9 (11.3%) patients with Caprini score >8 had a VTE event. Patients with Caprini score >8 were significantly more likely to develop VTE when compared with patients with Caprini score of 3 to 4 (odds ratio [OR] 20.9, p < 0.001), 5 to 6 (OR 9.9, p < 0.001), or 7 to 8 (OR 4.6, p = 0.015). Among patients with Caprini score 7 to 8 or Caprini score >8, VTE risk was not limited to the immediate postoperative period (postoperative days 1-14). In these high-risk patients, more than 50% of VTE events were diagnosed in the late (days 15-60) postoperative period.
  
  
  CONCLUSIONS
  The Caprini RAM effectively risk-stratifies plastic and reconstructive surgery patients for VTE risk. Among patients with Caprini score >8, 11.3% have a postoperative VTE when chemoprophylaxis is not provided. In higher risk patients, there was no evidence that VTE risk is limited to the immediate postoperative period.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, 48105, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pannucci
authors.forename: Steven H
authors.initials: SH
authors.lastname: Bailey
authors.forename: George
authors.initials: G
authors.lastname: Dreszer
authors.forename: Christine
authors.initials: C
authors.lastname: Fisher Wachtman
authors.forename: Justin W
authors.initials: JW
authors.lastname: Zumsteg
authors.forename: Reda M
authors.initials: RM
authors.lastname: Jaber
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hamill
authors.forename: Keith M
authors.initials: KM
authors.lastname: Hume
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
authors.forename: Loree K
authors.initials: LK
authors.lastname: Kalliainen
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Hoxworth
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control; D019651:Plastic Surgery Procedures; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin