Stratifying the Risk of Venous Thromboembolism in Otolaryngology

Abstract

Objective The consequences of perioperative venous thromboembolism (VTE) are devastating; identifying patients at risk is an essential step in reducing morbidity and mortality. The utility of perioperative VTE risk assessment in otolaryngology is unknown. This study was designed to risk-stratify a diverse population of otolaryngology patients for VTE events. Study Design Retrospective cohort study. Setting Single-institution academic tertiary care medical center. Subjects and Methods Adult patients presenting for otolaryngologic surgery requiring hospital admission from 2003 to 2010 who did not receive VTE chemoprophylaxis were included. The Caprini risk assessment was retrospectively scored via a validated method of electronic chart abstraction. Primary study variables were Caprini risk scores and the incidence of perioperative venous thromboembolic outcomes. Results A total of 2016 patients were identified. The overall 30-day rate of VTE was 1.3%. The incidence of VTE in patients with a Caprini risk score of 6 or less was 0.5%. For patients with scores of 7 or 8, the incidence was 2.4%. Patients with a Caprini risk score greater than 8 had an 18.3% incidence of VTE and were significantly more likely to develop a VTE when compared to patients with a Caprini risk score less than 8 (P <.001). The mean risk score for patients with VTE (7.4) was significantly higher than the risk score for patients without VTE (4.8) (P <.001). Conclusion The Caprini risk assessment model effectively risk-stratifies otolaryngology patients for 30-day VTE events and allows otolaryngologists to identify patient subgroups who have a higher risk of VTE in the absence of chemoprophylaxis.

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

“…[9][10][11]28 However, the model requires yes/no answers to 40 risk factor questions, which may limit physician compliance with completion. 13 The Rogers score was published in 2007 after being developed using rigorous statistical methods based on data from the Veterans Administration Patient Safety Study.…”

“…Studies have shown that a 10-to 20-fold difference in VTE risk exists among the overall surgical population. [8][9][10][11] The American College of Chest Physicians (ACCP) guidelines on VTE prevention have long been the standard for conceptualizing VTE risk. 12 The most recent ACCP guidelines, Antithrombotic Therapy and Prevention A nnually, 12 million hospitalized patients are at risk of VTE, which includes DVT and pulmonary embolus (PE).…”

Chemoprophylaxis for Venous Thromboembolism in Otolaryngology

“…8 The literature describes several methods of stratifying otolaryngology patients by risk for VTE. 8,10,11 One method is the Caprini risk assessment model. [10][11][12] This model is used to determine each patient's individual risk for VTE.…”

“…8,10,11 One method is the Caprini risk assessment model. [10][11][12] This model is used to determine each patient's individual risk for VTE. The Caprini model uses a point scoring system; the relative scores for each patient's risk factors are summed to produce a cumulative risk score that defines the patient's risk level and associated prophylaxis regimen.…”

Toward the individual approach to the evaluation of risks and prevention of postoperative venous thromboembolism

“…Модель J. Caprini прошла удачную ретроспек тивную валидацию у пациентов общехирургическо го, сосудистого и урологического профиля, боль ных, подвергшихся пластической и реконструктив ной хирургии, перенесших операции на ЛОР органах, а также у пациентов из отделений ОРИТ и получила мировое признание [104][105][106][107][108]. Между тем до сих пор модель J. Caprini была ограничена выде лением гетерогенной группы высокого риска по аналогии с традиционными оценочными система ми.…”