Evaluation of the Caprini Model for Venothromboembolism in Esophagectomy Patients.
BACKGROUND
Patients undergoing esophagectomy for cancer are in the highest-risk group for venous thromboembolism, with a 7.3% incidence reported by the National Surgical Quality Improvement Program. Venothromboembolism (VTE) doubles esophagectomy mortality. The Caprini risk assessment model (RAM) is a method to stratify postoperative thromboembolism risk for consideration of prolonged preventive anticoagulation in higher-risk patients. Our aim was to examine the potential use of this model for reducing the VTE incidence in esophagectomy patients.


METHODS
The records of patients who underwent an esophagectomy by the thoracic surgery service at our institution between June 2005 and June 2013 were reviewed. The inclusion criteria were a diagnosis of esophageal cancer treated with esophagectomy (any approach) and with available 60-day postoperative follow-up. Exclusion criteria were the presence of an inferior vena cava filter or chronic anticoagulation therapy. The Caprini risk score and the number of VTE events were recorded retrospectively for each patient.


RESULTS
Seventy patients satisfied eligibility criteria. The VTE incidence was 14.3%. Patients with esophageal thromboembolism had a higher Caprini score distribution than patients without thromboembolism (p < 0.001). Adjusted logistic regression analysis demonstrated increased odds of VTE with increasing score (p < 0.05), with good discrimination.


CONCLUSIONS
In this first report examining the Caprini model categories in an esophagectomy population, the VTE incidence in true high-risk patients was high. From this retrospective calculation of risk and events, patients in the highest-risk Caprini group may benefit from an enhanced course of postoperative anticoagulation.
School of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Philip D
PD
Hewes
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Krista J
KJ
Hachey
School of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Xue Wei
XW
Zhang
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Yorghos
Y
Tripodis
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Pamela
P
Rosenkranz
Section of Thoracic Surgery, Columbia University Medical Center, New York, New York.
Michael I
MI
Ebright
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
David
D
McAneny
Division of Thoracic Surgery, Boston University School of Medicine, Boston, Massachusetts.
Hiran C
HC
Fernando
Division of Thoracic Surgery, Boston University School of Medicine, Boston, Massachusetts. Electronic address: virginia.litle@bmc.org.
Virginia R
VR
Litle
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D000066491:Clinical Decision-Making; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control