Department of Surgery, University of Michigan, Ann Arbor, 48105, USA.
J Am Coll Surg. 2011 Jan;212(1):105-12. doi: 10.1016/j.jamcollsurg.2010.08.018. Epub 2010 Nov 18.
The Venous Thromboembolism Prevention Study (VTEPS) Network is a consortium of 5 tertiary referral centers established to examine venous thromboembolism (VTE) in plastic surgery patients. We report our midterm analyses of the study's control group to evaluate the incidence of VTE in patients who receive no chemoprophylaxis, and validate the Caprini Risk Assessment Model (RAM) in plastic surgery patients.
Medical record review was performed at VTEPS centers for all eligible plastic surgery patients between March 2006 and June 2009. Inclusion criteria were Caprini score ≥3, surgery under general anesthesia, and postoperative hospital admission. Patients who received chemoprophylaxis were excluded. Dependent variables included symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) within the first 60 postoperative days and time to DVT or PE.
We identified 1,126 historic control patients. The overall VTE incidence was 1.69%. Approximately 1 in 9 (11.3%) patients with Caprini score >8 had a VTE event. Patients with Caprini score >8 were significantly more likely to develop VTE when compared with patients with Caprini score of 3 to 4 (odds ratio [OR] 20.9, p < 0.001), 5 to 6 (OR 9.9, p < 0.001), or 7 to 8 (OR 4.6, p = 0.015). Among patients with Caprini score 7 to 8 or Caprini score >8, VTE risk was not limited to the immediate postoperative period (postoperative days 1-14). In these high-risk patients, more than 50% of VTE events were diagnosed in the late (days 15-60) postoperative period.
The Caprini RAM effectively risk-stratifies plastic and reconstructive surgery patients for VTE risk. Among patients with Caprini score >8, 11.3% have a postoperative VTE when chemoprophylaxis is not provided. In higher risk patients, there was no evidence that VTE risk is limited to the immediate postoperative period.
静脉血栓栓塞症预防研究（VTEPS）网络是由 5 个三级转诊中心组成的联盟，旨在检查整形手术患者的静脉血栓栓塞症（VTE）。我们报告了该研究对照组的中期分析结果，以评估未接受化学预防的患者发生 VTE 的发生率，并验证 Caprini 风险评估模型（RAM）在整形手术患者中的应用。
在 2006 年 3 月至 2009 年 6 月期间，VTEPS 中心对所有符合条件的整形手术患者进行了病历回顾。纳入标准为 Caprini 评分≥3、全身麻醉下手术和术后住院。排除接受化学预防的患者。因变量包括术后 60 天内出现症状性深静脉血栓形成（DVT）或肺栓塞（PE）和 DVT 或 PE 的时间。
我们确定了 1126 例历史对照患者。总的 VTE 发生率为 1.69%。大约每 9 例（11.3%）Caprini 评分>8 的患者中有 1 例发生 VTE 事件。与 Caprini 评分 3 至 4（比值比[OR]20.9，p<0.001）、5 至 6（OR 9.9，p<0.001）或 7 至 8（OR 4.6，p=0.015）的患者相比，Caprini 评分>8 的患者发生 VTE 的可能性显著更高。在 Caprini 评分 7 至 8 或 Caprini 评分>8 的患者中，VTE 风险不仅限于术后早期（术后 1-14 天）。在这些高危患者中，超过 50%的 VTE 事件发生在术后晚期（第 15-60 天）。
Caprini RAM 有效地对整形和重建手术患者的 VTE 风险进行风险分层。在未提供化学预防的情况下，Caprini 评分>8 的患者中有 11.3%在术后发生 VTE。在高危患者中，没有证据表明 VTE 风险仅限于术后早期。
