Applying the 2005 Caprini Score to Plastic Surgery Patients

Abstract

Background The Caprini score is a validated scale that calculates a patient's 30-day venous thromboembolism (VTE) risk based on their comorbidities. The American Society of Plastic Surgeons published VTE prophylaxis recommendations in 2011 based on the Caprini score, but these recommendations are vague and up to physician interpretation. The purpose of this study is to evaluate postoperative outcomes after the application of strict guidelines using the Caprini score with specific VTE chemoprophylaxis benchmarks on plastic surgery patients. Methods A retrospective cohort analysis was performed on all plastic surgery patients who underwent surgery between July 2019 and July 2021. Patients between July 2019 and June 2020 were not subjected to any specific VTE prophylaxis protocol, while patients from July 2020 to July 2021 were subjected to the newly created VTE prophylaxis protocol. Every patient received a calculated Caprini score at their preoperative history and physical. The primary outcomes measured include hematoma, deep vein thrombosis (DVT) and pulmonary embolism (PE). Results Four hundred forty-one patients with 541 procedures were included in this study, with 275 patients in the “before” group and 166 patients in the “after” group. A total of 78.6% of patients received chemoprophylaxis in the “before” group compared with 20% in the “after” group. There was no significant difference in postoperative complications between the two groups including PE or DVT (P = 0.2684 and 0.2696, respectively), with a trend toward hematoma formation in the “before” group (P = 0.1358). After the application of evidence-based VTE guidelines, the patients stayed fewer days in the hospital (0.4 vs 0.7 days, P = 0.0085) and were less likely to be readmitted (2.4% vs 6.5%, P = 0.0333). The average cost per patient in the “before” group was $9.11 with a total cost of $3022.90. The average cost per patient in the “after” group was $4.23 with a total cost of $867.94 (P = 0.032). Conclusions Our strict application of the Caprini score significantly and safely limited the number of patients receiving postoperative VTE chemoprophylaxis and showed no significant difference in postoperative hematoma, DVT, or PE.

Abandoning Caprini Scores and Chemoprophylaxis (“Bloodletting 2.0”): A Call for Action

“…Evidence that challenges the conventional wisdom may be accepted or rejected, but it cannot be simply ignored 22 . By not recognizing a whole body of literature supporting an opposing viewpoint, 1,56 recent investigators do a disservice to the scientific method and to their own efforts 50 . Modifying anesthesia to avoid muscle paralysis and preserve the calf muscle pump is essential to reduce VTE risk 3,34,43 .…”

“…The authors' plan included either chemoprophylaxis or postponing surgery for medical optimization for patients with scores ≥8. Nevertheless, the authors operated on a patient with a Caprini score of 17 in the earlier group and 13 in the more recent group 1 …”

“…The corresponding author and former journal editor-in-chief writes: “The authors would like to express great appreciation to Dr. Pannucci for his valuable and constructive suggestions during the development of the manuscript, as well as his overall contribution to studying venous thromboembolism. His dedication to the safety of our patients is very much appreciated.” 7 Remarkably, none of the references cited by Dahmus et al 1 are to articles that are critical of risk stratification and chemoprophylaxis or recommend an alternative treatment strategy, despite numerous references in the literature over the last decade, 3,5,11,15–25 including the only prospective study in a large number (n = 1,000) of patients all screened with Doppler ultrasound 11 and the only published Level 1 randomized trial 20 …”

“…Ultrasound is FDA (Food and Drug Administration) cleared for accurate detection of DVTs 22 . Proponents of chemoprophylaxis rarely disclose the fact that chemoprophylaxis in plastic surgery patients is an off-label application 1,4,9,14 . Chemoprophylaxis is not approved by the US FDA for plastic surgery patients.…”

“…Venous thromboembolism research generates a bewildering volume of data and statistics 1,7,14,26–32,40–46,55,56 . It might even be said that today VTEs are the number one cause of statistics in plastic surgery.…”