title: Analysis of the American Society of Anesthesiologists Physical Status Classification System and Caprini Risk Assessment Model in Predicting Venous Thromboembolic Outcomes in Plastic Surgery Patients.
abstract: BACKGROUND
  Venous thromboembolism (VTE) can be a fatal outcome of plastic surgery. Risk assessment models attempt to determine a patient's risk, yet few studies have compared different models in plastic surgery patients.
  
  
  OBJECTIVE
  The authors investigated preoperative ASA physical status and 2005 Caprini scores to determine which model was more predictive of VTE.
  
  
  METHODS
  A retrospective chart review examined 1801 patients undergoing contouring and reconstructive procedures from January 2008 to January 2012. Patients were grouped into risk tiers for ASA scores (1-2 = low, 3+ = high) with 2 cutoffs for Caprini scores (1-4 = low, 5+ high; 1-5 = low, 6+ = high), then re-stratified into 3 tiers using Caprini score cutoffs (1-4 = low, 5-8 = high, 9+ = highest; 1-5 = low, 6-8 = high, 9+ = highest). Median scores of VTE patients were compared to those without VTE. Odds ratio and chi-squared analyses were performed.
  
  
  RESULTS
  Of the 1598 patients included in the study, 1.50% developed VTE. Median ASA scores differed significantly between comparison groups but Caprini scores did not vary regardless of cutoff. When examining the 2-tiered Caprini scores, using low risk = 1-5 showed a significant relationship between risk tier and DVT development (P = 0.0266).
  
  
  CONCLUSIONS
  The ASA system yielded the highest odds ratio of VTE development between low and high-risk patients. The Caprini model captured more patients with VTE in its high-risk category. Combining the two models for a more heuristic approach to preoperative care may identify patients at higher risk.
  
  
  METHODS
  4 Risk.
authors.affiliation: Messrs Shaikh, Jeong, and Mastro are medical students, Dr Davis is Co-director of Research, and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas TX.
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Shaikh
authors.affiliation: Messrs Shaikh, Jeong, and Mastro are medical students, Dr Davis is Co-director of Research, and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas TX.
authors.forename: Haneol S
authors.initials: HS
authors.lastname: Jeong
authors.affiliation: Messrs Shaikh, Jeong, and Mastro are medical students, Dr Davis is Co-director of Research, and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas TX.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mastro
authors.affiliation: Messrs Shaikh, Jeong, and Mastro are medical students, Dr Davis is Co-director of Research, and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas TX.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Davis
authors.affiliation: Messrs Shaikh, Jeong, and Mastro are medical students, Dr Davis is Co-director of Research, and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas TX.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Lysikowski
authors.affiliation: Messrs Shaikh, Jeong, and Mastro are medical students, Dr Davis is Co-director of Research, and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas TX.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Kenkel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D003357:Cosmetic Techniques / Q000009:adverse effects*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013781:Texas; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D055815:Young Adult