Weitzman Rachel E, Zhao Karena, Sclafani Matthew S, Srinivasan Yashes, Stein Eli, Cole Arron, Sclafani Anthony P
Department of Otolaryngology - Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, U.S.A.
Weill Cornell Medicine, New York, New York, U.S.A.
Laryngoscope. 2025 Apr;135(4):1359-1366. doi: 10.1002/lary.31856. Epub 2024 Oct 29.
Venous thromboembolic events (VTEs) are a leading cause of postoperative morbidity, prolonged hospital stay, and increased cost. Recommendations for mechano- and chemoprophylaxis are currently based on the 2005 Caprini score, a screening tool developed to identify patients at risk for VTE. The Caprini risk assessment model (RAM) was designed for surgical impatients and has been tested in a number of surgical fields, including otolaryngology. However, the vast majority of otolaryngology cases are performed as ambulatory surgery. Simpler RAMs include the COBRA scoring system and Pannucci-NSQIP. Here, we evaluate risk stratification of otolaryngology surgical patients and correlate the findings of these three RAMs.
Retrospective chart review.
A retrospective chart review of 869 patients undergoing surgery by Weill Cornell faculty otolaryngologists between June and December 2022 was performed. Patient demographics, VTE risk factors, admission status, surgical subservice, and postoperative events were collected, and RAM scores were calculated for each patient. Wilcoxon and Kruskal-Wallis rank-sum tests were utilized to assess differences in VTE risk scores based on type of procedure and admission status, and Spearman's correlation was utilized to assess agreement between the three different scoring systems. Multivariate linear regressions were utilized to assess variables that impacted the Caprini, COBRA, and NSQIP RAMs.
In total, two patients developed postoperative venous thromboembolism. Furthermore, there is a strong positive correlation between Caprini and COBRA RAMs (even when broken down by admission status, although it weakens in the inpatient population). There is a moderate positive correlation between Caprini and Pannucci-NSQIP in the full cohort, but that correlation is lost in the inpatient population.
Otolaryngology surgical patients are at low risk of postoperative VTE. Caprini, Pannucci-NSQIP, and COBRA RAMs correlate well in determining ambulatory patients at risk for postoperative VTE and shorter, simpler RAMS such as COBRA and Pannucci-NSQIP can be used instead of Caprini RAM.
3 Laryngoscope, 135:1359-1366, 2025.
静脉血栓栓塞事件（VTEs）是术后发病、住院时间延长和费用增加的主要原因。目前机械预防和化学预防的建议基于2005年的Caprini评分，这是一种用于识别VTE风险患者的筛查工具。Caprini风险评估模型（RAM）是为外科住院患者设计的，并已在包括耳鼻喉科在内的多个外科领域进行了测试。然而，绝大多数耳鼻喉科手术是门诊手术。更简单的RAM包括COBRA评分系统和Pannucci-NSQIP。在此，我们评估耳鼻喉科手术患者的风险分层，并关联这三种RAM的结果。
回顾性病历审查。
对2022年6月至12月间威尔康奈尔医学院耳鼻喉科教员进行手术的869例患者进行回顾性病历审查。收集患者人口统计学资料、VTE风险因素、入院状态、手术科室和术后事件，并计算每位患者的RAM评分。采用Wilcoxon和Kruskal-Wallis秩和检验评估基于手术类型和入院状态的VTE风险评分差异，采用Spearman相关性分析评估三种不同评分系统之间的一致性。采用多变量线性回归评估影响Caprini、COBRA和NSQIP RAM的变量。
共有2例患者发生术后静脉血栓栓塞。此外，Caprini和COBRA RAM之间存在强正相关（即使按入院状态细分，尽管在住院患者中相关性减弱）。在整个队列中，Caprini和Pannucci-NSQIP之间存在中度正相关，但在住院患者中这种相关性消失。
耳鼻喉科手术患者术后发生VTE的风险较低。Caprini、Pannucci-NSQIP和COBRA RAM在确定有术后VTE风险的门诊患者方面具有良好的相关性，并且可以使用更简短、更简单的RAM，如COBRA和Pannucci-NSQIP，来替代Caprini RAM。
3 《喉镜》，135:13
