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Venous Thromboembolism Risk in Breast Reconstruction: Application of the Caprini Risk Assessment Model
Casey Zhang, BA; Dhipthika Srinivasan, DO; Xiao Zhu, MD; Vu T. Nguyen, MD
University of Pittsburgh Medical Center
2024-01-13
Presenter: Casey Zhang
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. I certify that this work entirely represents the original work of the resident or medical student.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
The Caprini Risk Assessment Model is the most clinically validated model to assess risk of venous thromboembolism (VTE) in surgical patients. This study aims to understand the risk of VTE in women undergoing breast reconstruction using this model.
Methods:
This was a retrospective cohort study utilizing The National Surgical Quality Improvement Quality Program (NSQIP) database to identify patients who underwent breast reconstruction. After assigning a Caprini score to each patient, univariate regression analysis was performed to test for association with VTE.
Results:
A total of 73,176 patients were included. 325 (0.4%) patients developed VTE. For each unit increase in Caprini score, there was 1.47 times increase in odds of VTE (OR 1.47, CI 1.303-1.648, p<0.001). Risk of VTE was 5.17 times higher in autologous reconstruction than implant-based (OR 5.17, CI 4.096-6.514, p<.001). In autologous reconstruction, a Caprini score of 6 or over was significantly associated with higher odds of VTE (OR 1.51, CI 1.136-2.017, p=.005); no significant association was noted in implant-based reconstruction (OR 1.356, CI 0.892-2.059, p=.154). Abdominal free flaps were associated with significantly higher odds of VTE compared to latissimus dorsi and pedicled TRAM reconstruction (OR 1.74, CI 1.253-2.421, p>.001).
Conclusion:
This study validates the Caprini Risk Assessment model in breast reconstruction, confirming previous findings that autologous reconstruction is associated with higher risk of VTE. We recommend 7-10 days of post-operative VTE chemoprophylaxis for this high-risk population undergoing autologous reconstruction with a Caprini score of 6 or over. Similar prophylaxis measures can be considered in implant-based reconstruction.
