White Amelia J, Kanapathy Muholan, Nikkhah Dariush, Akhavani Mo
Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom.
Division of Surgery & Interventional Science, University College London, London, United Kingdom.
JPRAS Open. 2021 Aug 11;30:116-127. doi: 10.1016/j.jpra.2021.07.010. eCollection 2021 Dec.
A reliable venous thromboembolism (VTE) risk assessment model (RAM) can assist surgeons in identifying patients who would benefit from VTE prophylaxis. This systematic review was aimed at summarising the current available evidence on VTE RAMs used in aesthetic plastic surgery.
A comprehensive search was performed in the PubMed, EMBASE and Cochrane databases to include primary studies describing VTE RAMs in aesthetic plastic surgery from 1946 to February 2019. The objective was to compare the different VTE RAMs described for aesthetic plastic surgery to recommend a reliable model to stratify patients.
Of the 557 articles identified in the PubMed, EMBASE and Cochrane databases, six articles were included in the final review. Five different RAMs were used in the included studies: Caprini 2005 RAM, Caprini 2010 RAM, Davison-Caprini 2004 RAM, the American Society of Anaesthesiologist's (ASA) physical status grading system and a tool developed by Wes et al. The difference in risk weightage amongst the tools along with the VTE incidences for different categories was compared. The Caprini 2005 RAM was the most widely reported tool and validated in plastic surgery patients.
Amongst the five different tools currently used, the Caprini 2005 RAM was the most widely reported. This tool was validated in plastic surgery patients and reported to be a sensitive and reliable tool for VTE risk stratification; therefore, current data support its use until further higher quality evidence becomes available. Because of the heterogeneity of the data and low quality of the current evidence, a definitive recommendation cannot be made on the best VTE RAM for patients undergoing aesthetic plastic surgery. This paper highlights the need for randomised controlled trials evaluating the various RAMs which are essential to support future recommendations and guidelines.
可靠的静脉血栓栓塞症（VTE）风险评估模型（RAM）可帮助外科医生识别能从VTE预防措施中获益的患者。本系统评价旨在总结目前关于美容整形手术中使用的VTE RAM的现有证据。
在PubMed、EMBASE和Cochrane数据库中进行全面检索，纳入1946年至2019年2月描述美容整形手术中VTE RAM的原始研究。目的是比较所描述的用于美容整形手术的不同VTE RAM，以推荐一个可靠的模型对患者进行分层。
在PubMed、EMBASE和Cochrane数据库中识别出的557篇文章中，最终纳入6篇进行综述。纳入研究中使用了5种不同的RAM：2005年卡普里尼RAM、2010年卡普里尼RAM、戴维森-卡普里尼2004年RAM、美国麻醉医师协会（ASA）身体状况分级系统以及韦斯等人开发的一种工具。比较了这些工具在风险权重上的差异以及不同类别患者的VTE发生率。2005年卡普里尼RAM是报道最广泛的工具，且在整形外科患者中得到验证。
在目前使用的5种不同工具中，2005年卡普里尼RAM报道最为广泛。该工具在整形外科患者中得到验证，据报道是一种用于VTE风险分层的敏感且可靠的工具；因此，目前的数据支持在有更高质量证据可用之前使用该工具。由于数据的异质性和当前证据质量较低，无法就美容整形手术患者的最佳VTE RAM做出明确推荐。本文强调需要进行随机对照试验来评估各种RAM，这对于支持未来的推荐和指南至关重要。
