Application of the Caprini Risk Assessment Model in Evaluation of Non–Venous Thromboembolism Complications in Plastic and Reconstructive Surgery Patients

Jeong, Haneol S.; Miller, Travis J.; Davis, Kathryn E.; Matthew, Anoop; Lysikowski, Jerzy; Lazcano, Eric; Reed, Gary; Kenkel, Jeffrey M.

doi:10.1177/1090820x13514077

Cited by 40 publications

(25 citation statements)

References 34 publications

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“…The 2005 Caprini Risk Assessment Model score has been validated in plastic surgery patients and is an effective risk-stratification tool. 28,29 Using this model, essentially, all breast cancer patients undergoing mastectomy are classified as "high risk." 30 In 2011, following the only case (group C) of venous thromboembolism observed at our department, the Caprini score was modified by a multidisciplinary team including hematologist, plastic surgeon, anesthesiologist, and medical internist.…”

Section: Discussionmentioning

confidence: 99%

Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results

Laporta

Sorotos

Longo

et al. 2017

J reconstr Microsurg

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Correlation among age, clinical, and aesthetic outcomes in implant-based and autologous breast reconstructions was investigated. Between 2004 and 2014, a retrospective study was performed on patients who underwent reconstruction following mastectomy. Patients were divided in group A (< 50 years), group B (≥ 50-59 years), group C (≥ 60-69 years), and group D (≥ 70 years). Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and length of stay were assessed using chi-square and Kruskal-Wallis analysis considering ≤ 0.05 as significant. Pre- and postoperative photographs were taken to grade aesthetic results by patients and blinded plastic surgery team. A total of 993 patients underwent 1,251 breast reconstructions, of which 356 (28.5%) were implant-based, 402 (32.1%) pedicled-flap, 445 (35.6%) free-flap, and 48 (3.8%) fat-graft reconstructions. There were 316 (25.2%) complications, of which 124 (34.8%) in implant-based, 74 (18.4%) in pedicled-flap, 111 (24.9%) in free-flap, and 2 (4.2%) in fat-graft reconstructions. Mean length of stay was 5.4 days without significant difference between age groups ( = 0.357). The incidence of overall complications was not significantly related to age, ASA class, smoking history, and previous radiotherapy. Body mass index was a significant predictor ( = 0.001), but odds ratio (OR: 1.2) demonstrated only a minimal increase in risk. Implant-based reconstruction was associated with a higher risk for complications compared with the other ones (OR: 2.5, = 0.001). Patient and surgeon aesthetic surveys demonstrated an overall positive opinion in all age groups for each reconstructive option. Advanced age should not be considered a risk factor for breast reconstruction, while implant-based technique was associated with a higher risk for complications compared with autologous that may provide older women with greater benefits.

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Section: Discussionmentioning

confidence: 99%

Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results

Laporta

Sorotos

Longo

et al. 2017

J reconstr Microsurg

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“…Many studies show no relationship between age and risk for complications (45,57,(60)(61)(62)(66)(67)(68)(69)(70)(71), while other studies show that elderly patients have more risk (44,53,63). Diabetes has been associated with postoperative complications after autologous reconstruction, but the results after implantbased breast reconstruction are more conflicting (52,(72)(73)(74)(75). Patients with renal disease seem to be more prone to complications (75,76).…”

Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 86%

“…Diabetes has been associated with postoperative complications after autologous reconstruction, but the results after implantbased breast reconstruction are more conflicting (52,(72)(73)(74)(75). Patients with renal disease seem to be more prone to complications (75,76). Very little has been published on the history of DVT and postoperative complications, but one study showed an increased risk for thrombosis in free flap surgery in hypercoagulative patients and a very low salvage rate of the affected flaps (77).…”

Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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“…Unfortunately, no clinically validated protocol dedicated to varicose vein patients undergoing chronic venous disease treatment has been established. The Caprini scale, which is commonly used for surgical patients, has only been validated in some populations, such as intensive care patients, surgical patients and those undergoing plastic surgery [54][55][56][57], but not for patients undergoing varicose vein surgery or receiving minimally invasive treatment for chronic venous disease. As mentioned before, according to the study of Rhee et al, the Caprini risk score should be considered in the EHIT risk assessment [48].…”

Section: Venous Thromboembolism Prophylaxis After Varicose Vein Surgementioning

confidence: 99%

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

Wołkowski¹,

Urbanek²

2018

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Deep vein thrombosis (DVT) remains one of the most important clinical complications of varicose vein surgery. Despite the fact that procedures employed in the treatment of varicose veins are commonly classified as carrying a low risk of thromboembolism, this risk may vary significantly across different patients due to the presence of individual risk factors. This is a review of the risk of DVT in surgical and minimally invasive treatment of varicose veins. In retrospective studies addressing open varicose vein surgery, the rate of symptomatic DVT has been estimated at approximately 1%, but in prospective imaging-based studies, the risk of DVT in clinical settings seems to be much higher. The role of risk factors for DVT as well as their proper evaluation and individual risk stratification are significant. Because of population aging, a higher incidence of thromboembolic complications can be expected, suggesting the need for an individualised approach to risk stratification and appropriate risk-adjusted prophylaxis in patients who are candidates for varicose vein treatment. The implementation of new treatment modalities, in particular thermal and non-thermal ablation, does not eliminate the risk of DVT completely despite their relatively minimally invasive nature. Moreover, these methods can be related to the occurrence of new types of thrombotic complications, such as endovenous heat-induced thrombosis. The limited number of prospective studies regarding thromboembolism prophylaxis in modern phlebological treatment warrants further research on the importance of patient assessment and evaluation of procedure-related risk factors for venous thromboembolism.

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Application of the Caprini Risk Assessment Model in Evaluation of Non–Venous Thromboembolism Complications in Plastic and Reconstructive Surgery Patients

Cited by 40 publications

References 34 publications

Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results

Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

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