Mohammad-Ali Shaikh1, Haneol S Jeong1, Andrew Mastro1, Kathryn Davis1, Jerzy Lysikowski1, Jeffrey M Kenkel1. 1. 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.
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). CONCLUSION: 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. LEVEL OF EVIDENCE: 4 Risk.
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 VTEpatients 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). CONCLUSION: 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. LEVEL OF EVIDENCE: 4 Risk.