Assessment Tool Predicts VTE Risk after Plastic Surgery

Article

A recent study shows that patients undergoing plastic or reconstructive surgery can benefit from individual blood clot risk assessments.

Patients undergoing plastic or reconstructive surgery should receive a risk assessment prior to the procedure to predict whether they will develop potentially fatal blood clots in the legs or lungs, according to research published in the Journal of the American College of Surgeons. Researchers also found that one in nine patients at highest risk based on that assessment will develop clots if not given clot-preventing medications after surgery.

In the study, lead author Christopher J. Pannucci, MD, MS, of the University of Michigan Section of Plastic and Reconstructive Surgery and colleagues evaluated a standard measurement tool used to assess the likelihood a patient will develop dangerous clots in the deep veins of the legs or lungs after surgery. Data from the study show that the Caprini Risk Assessment Model “is a useful and effective tool for predicting how likely a patient is to develop venous thromboembolism (VTE) after plastic surgery,” said Pannucci in a statement.

Because past research has shown that some plastic and reconstructive surgery patients are at high risk for developing clots and only about 50% of surgeons administer clot-preventing medications after surgery, Pannucci and fellow researchers sought to specifically validate whether the Caprini model was an effective tool for predicting risk and whether administering clot-preventing medications after surgery can reduce their risk.

“We found that the higher a patient’s Caprini score, the more likely the patient is to develop blood clots after surgery,” he noted. “We also found that patients with the highest scores were at disproportionately greater risk for developing clots if no clot-preventing medications were administered within 60 days after surgery.”

For the study—which was part of the Venous Thromboembolism Prevention Study (VTEPS) Network established to examine the risk of venous thromboembolism (VTE) in plastic surgery patients—Pannucci and colleagues reviewed medical record data from 1,126 patients who had plastic or reconstructive surgery and who received no clot-preventing medicines after surgery. They determined that the Caprini Risk Assessment tool is effective in predicting which plastic and reconstructive surgery patients will develop VTE. They also found that Patients with a Caprini score greater than 8 are at disproportionately higher risk for developing late VTE; one in nine of these patients can expect to have an event if no clot-preventing medication is given within 60 days after the surgery.

“We used to think people developed blood clots while still on the operating table,” Pannucci said. “But we showed that patients with lower risk scores tend to develop VTEs within two weeks after surgery, while patients with higher risk scores continue to be at risk 20, 40 and even 60 days after their operation.”

These findings are significant, said the authors, as VTE occurs with particularly high frequency after post-bariatric body contouring surgery, including circumferential abdominoplasty (7.7%), abdominoplasty (5%), and breast or upper body contouring (2.9%) and certain types of breast reconstruction (2.2%) procedures.

For more information on preventing VTE, read the cover story in the October issue of MDNG: Hospitalist (Spotlight on VTE Prevention).

Are patients who undergo plastic or reconstructive surgical procedures at your facility screened beforehand to determine whether they will develop blood costs? If so, what methods are used?

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