D. E. Wang1, R. Hollis1, G. Tan1, M. O’Doherty1, M. L. Greenwald1 1North Shore University And Long Island Jewish Medical Center, Surgery, Manhasset, NY, USA
Introduction: Venous thromboembolism (VTE) is a preventable complication associated with significant morbidity and healthcare costs. Caprini Score is a validated tool that predicts VTE risk in surgical patients. We hypothesize that patients with Caprini Score ≥7 are at elevated risk for VTE and should be discharged on prophylaxis.
Methods: We compared all patients undergoing major colorectal surgery at our institution to patients from the NSQIP database in 2019. Our practice is to discharge patients at elevated risk for VTE (Caprini Score ≥7) with 28 days of chemoprophylaxis. Caprini Scores were calculated for both groups and the rate of VTE (deep venous thrombosis or pulmonary embolus within 30 days postoperatively) was determined. Risk of VTE was assessed with univariate multiple logistic regression in the NSQIP group. Patient characteristics were compared using Chi-Squared test and Fisher’s Exact Test.
Results: A total of 434 patients from our institution were compared to 74,892 patients meeting inclusion criteria from the NSQIP database. Patients with Caprini Scores ≥ 7 were 73% more likely to develop postoperative VTE compared to those with Caprini Scores < 7 (95% CI [1.56, 1.93], p<0.001). Compared to NSQIP data, patients from our institution were more likely to be female (52.4% vs. 58.1%, p=0.018), white (66.6% vs. 77.4%, p<0.001), and less obese (BMI >25 in 66.1% vs. 59.9%, p=0.007). However, estimated VTE risk was similar between the groups. Mean Caprini Scores and proportion of patients with Caprini Scores ≥ 7 were similar (6.39 vs. 6.49, p=0.344; 44.7% vs. 44.7% p=0.995). Compared to the national sample, the overall rate of postoperative VTE in our sample was significantly lower (1.89% vs. 0.69% p= 0.036). Readmission rates were similar between the two groups (10.5% vs. 12.7%, p=0.133) and none of the readmissions within the study group were related to bleeding complications. Risk factors beyond elements of the Caprini Score were examined within the NSQIP group, demonstrating that patients with VTE were also more likely to have ascites, renal failure, metastatic disease, open wounds, significant weight loss (>10%), immunosuppression, received blood transfusions, and had emergent, contaminated, or dirty cases (p<0.001 for all).
Conclusion: The Caprini Score may be helpful to identify postoperative colorectal surgery patients at elevated risk for VTE who would benefit from 4 weeks of chemoprophylaxis upon discharge. Our findings suggest benefit for patients with Caprini Scores ≥ 7.
