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Validation of the Caprini risk assessment model for venous thromboembolism in deep inferior epigastric perforator flap breast reconstruction
Shannon S. Wu BA; Charlie Raymer MD; August Culbert BS; Rachel Schafer BS;
Risal Djohan MD; Steven Bernard MD; Raymond Isakov MD; Graham Schwarz MD; Sarah Bishop
MD; Raffi Gurunian MD
Cleveland Clinic
2022-01-14
Presenter: August Culbert
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The abstract reflects the original work of the author listed.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Deep inferior epigastric perforator (DIEP) flaps are commonly used for autologous breast reconstruction, but reported rates of venous thromboembolism (VTE) remain high. This study aimed to test the predictive value of the Caprini model for VTE in DIEP breast reconstruction.
Methods
This retrospective study included patients who underwent unilateral or bilateral DIEP flaps for breast reconstruction between 2016-2020 at a multicenter institution. Demographic and operative characteristics were recorded. The receiver operating characteristic (ROC) analysis was performed to test Caprini score for VTE. Univariate and multivariate analyses assessed risk factors that predicted VTE.
Results
This study included 524 patients (mean age 51.2ą9.6). 84% had BMI≥25. Median Caprini score was 5 (range, 2-11), with 122 (23.3%) moderate-risk (Caprini 3-4), 393 (75.0%) high-risk (Caprini 5-8), and 8 (1.5%) very high-risk (Caprini ≥9). DIEP surgery was bilateral in 278 (53.1%) and unilateral in 246 (46.9%) cases, and delayed in 282 (53.8%) and immediate in 242 (46.2%) cases. Mean operating time was 9.9ą2.9 hours. The incidence of postoperative VTE was 2.1%. No independent factor was significantly associated with VTE events on univariate or multivariate analysis. Raw Caprini score achieved an area under the curve (AUC) of 0.724 demonstrating good predictive ability.
Conclusions
This is the first study to demonstrate the validity of the Caprini model in DIEP flap breast reconstruction. Caprini score showed good predictive value for VTE events, despite no independent variable being significantly associated with VTE.
