Applying the 2005 Caprini Score to Plastic Surgery Patients: A Quality Improvement Project
Emma S Dahmus, MD, MBA1; Jamaica Westfall-Snyder, MD2; Julia Schroer, MS, MBA2; Christian A Kauffman, MD3; Joseph DeSantis, MD3; Sean Devitt, MD1
1Geisinger Medical Center
BACKGROUND: The Caprini Score is a validated scale that calculates a patient’s 30-day venous thromboembolism (VTE) risk based upon their comorbidities. The American Society of Plastic Surgeons published VTE prophylaxis recommendations in 2011 based upon the Caprini Scale, but these recommendations are vague and up to physician interpretation. The purpose of this study is to evaluate post-operative outcomes after the application of strict guidelines utilizing 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 to July 2021. Every patient received a calculated Caprini Score at their pre-operative history and physical. Our evidence-based guidelines indicated patients for the following: a Caprini Score less than 3 indicated sequential compression devices (SCDs) only, a score of 3-6 AND ambulatory surgery indicated SCDs only, a score of 3-6 AND admitted indicated a discussion with the admitting physician for the need for post-operative Lovenox, a score of 6-7 indicated post-operative Lovenox unless the procedure had a high risk for bleeding, and a score of 8 or greater indicated post-operative Lovenox or surgery was postponed for medical optimization. These patients were separated into two groups. Patients from July 1, 2019 to June 30, 2020 were designated as “Before”, and not subjected to the strict guidelines. The second group, designated as “After”, was screened with the strict VTE prophylaxis guidelines from July 1, 2020 to July 1, 2021. The primary outcomes measured included hematoma, deep vein thrombosis (DVT) and pulmonary embolism (PE).
RESULTS: 441 patients were included in this study, with 275 patients in the “Before” group and 166 patients in the “After” group. 78.6% of patients received chemoprophylaxis in the “Before” group compared to 20% in the “After” group. There was no significant difference in post-operative complications between the two groups including PE or DVT (p = 0.2684 and 0.2696, respectively), with a trend towards 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).
CONCLUSION: Our strict application of the Caprini Score significantly limited the number of patients receiving post-operative Lovenox and showed that there is no significant difference in post-operative hematoma, DVT or PE between the two groups.
Back to 2022 Posters