Analysis of the American Society of Anesthesiologists Physical Status Classification System and Caprini Risk Assessment Model in Predicting Venous Thromboembolic Outcomes in Plastic Surgery Patients

Shaikh, Mohammad Ali; Jeong, Haneol S.; Mastro, Andrew; Davis, Katie Ellen; Lysikowski, Jerzy; Kenkel, Jeffrey M.

doi:10.1093/asj/sjv198

Cited by 36 publications

(33 citation statements)

References 36 publications

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“…The multivariate analysis in the present study revealed that knee surgery with TKA or UKA is one of the factors associated with the preoperative DVT. Besides knee surgery, the other factors found to be associated with preoperative DVT in our analysis were advanced age, ASA physical status, and malignancy, which were consistent with the previously reported risk factors of postoperative VTE [ 3 , 20 ]. In patients with knee osteoarthritis, restricted knee flexion and extension due to knee pain or limited joint range of motion may result in DVT prevalence in the veins of the lower extremities.…”

Section: Discussionsupporting

confidence: 91%

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

Sato

Date

Michikawa

et al. 2021

BMC Musculoskelet Disord

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Background Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for degenerative musculoskeletal disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT. Methods The clinical data of patients aged ≥ 30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 µg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography. Results Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 µg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4 %. No patient had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥ 80 years (odds ratio [OR], 95 % confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence. Conclusions This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

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Section: Discussionsupporting

confidence: 91%

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

Sato

Date

Michikawa

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…The multivariate analysis in the present study revealed that knee surgery with TKA or UKA is one of the factors associated with the preoperative DVT. Besides knee surgery, the other factors found to be associated with preoperative DVT in our analysis were advanced age, ASA physical status, and malignancy, which were consistent with the previously reported risk factors of postoperative VTE [3,19]. In patients with knee osteoarthritis, restricted knee exion and extension due to knee pain or limited joint range of motion may result in DVT prevalence in the veins of the lower extremities.…”

Section: Discussionsupporting

confidence: 90%

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Sato

Date

Michikawa

et al. 2021

Preprint

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Background: Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for musculoskeletal degenerative disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT.Methods: The clinical data of patients aged ≥30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 μg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography.Results: Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 μg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4%. One patient (0.08%) had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥80 years (odds ratio [OR], 95% confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence.Conclusions: This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

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“…The Caprini score (CS) is widely used to assess for surgical patients (Caprini, 2005). It was validated in for plastic and reconstructive surgery patients in several large cohort studies and demonstrated that higher CS was associated with a higher incidence of VTE (Pannucci et al., 2011; Shaikh et al., 2016; Yago et al., 2019). CS is recommended in American Society of Clinical Oncology (ASCO) Guidelines for patients undergoing breast surgery (Surgeons, 2016).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a risk assessment nomogram for venous thromboembolism associated with hospitalized postoperative Chinese breast cancer patients

Qiang

Wang

et al. 2020

Journal of Advanced Nursing

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Aim The purpose of this study was to develop and validate an individualized nomogram to predict venous thromboembolism (VTE) risk in hospitalized postoperative breast cancer patients. Design A single‐central retrospective and non‐interventional trial. Methods For model development, we used data from 4,755 breast cancer patients between 1 November 2016–30 June 2018 (3,310 patients in the development group and 1,445 in the validation group). Overall, 216 patients developed VTE (150 in development group and 66 in validation group). The model was validated by receiver operating characteristic curves and the calibration plot. The clinical utility of the model was determined through decision curve analysis. Results The individualized nomogram consisted of six clinical factors: age, body mass index, number of cardiovascular comorbidities, neoadjuvant chemotherapy, surgical treatment, hospital length of stay and two pre‐operative biomarkers of Homocysteine and D‐dimer. The model at the 3.9% optimal cut‐off had the area under the curve of 0.854 (95% CI, 0.824–0.884) and 0.805 (95% CI, 0.740–0.870) in the development and validation groups. A p = 0.570 of the calibration test showed that the model was well‐calibrated. The net benefit of the model was better between threshold probabilities of 5%–30% in decision curve analysis. Conclusion The nomogram of VTE risk assessment, is applicable to hospitalized postoperative breast cancer patients. However, multi‐central prospective studies are needed to improve and validate the model. Effectiveness and safety of thromboprophylaxis in high‐risk patients are needed to demonstrate in interventional trials. Impact This nomogram can be used in clinical to inform practice of physicians and nurses to predict the VTE probability and maybe direct personalized decision making for thromboprophylaxis in hospitalized postoperative breast cancer patients.

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Analysis of the American Society of Anesthesiologists Physical Status Classification System and Caprini Risk Assessment Model in Predicting Venous Thromboembolic Outcomes in Plastic Surgery Patients

Abstract: 4 Risk.

Cited by 36 publications

References 36 publications

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Development and validation of a risk assessment nomogram for venous thromboembolism associated with hospitalized postoperative Chinese breast cancer patients

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