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abstract:
The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients
Background
Use
of risk assessment tools, such as the Caprini score or Rogers score, is
recommended by national societies to stratify surgical patients by
venous thromboembolism risk and guide prophylaxis. However, these tools
were not developed in a gynecological oncology patient population, and
their utility in this population is unknown.
Objective
The
objective of the study was to examine the ability of both the Caprini
and Rogers scores to stratify gynecological oncology patients by the
risk of venous thromboembolism.
Study Design
Patients
undergoing surgery for cervical, ovarian, uterine, vaginal, and vulvar
cancers between 2008 and 2013 were identified from the National Surgical
Quality Improvement Program Database using International Classification of Diseases,
ninth revision, codes. The Caprini and Rogers scores were calculated
for each patient based on the recorded demographic and procedure data.
Venous thromboembolism events were recorded for 30 days postoperatively.
Patients were categorized into risk groups based on the calculated
Caprini and Rogers scores and the incidence of venous thromboembolism,
and the 95% confidence interval was estimated for each of these groups.
The relationship between the risk score and venous thromboembolism
incidence was examined with Pearson’s correlation coefficient.
Results
Of
17,713 patients, 1.8% developed a venous thromboembolism. No patients
were classified by the Caprini score as low risk, 0.1% were moderate
risk, 3.0% were higher risk (score 4), and 96.9% were highest risk
(score ≥5). The Caprini score groupings did not correlate with venous
thromboembolism. The high-risk group had a paradoxically higher
incidence of venous thromboembolism of 2.5% compared with the
highest-risk group, 1.7% (P = .40). However, when the
highest-risk group of the Caprini score was substratified, it was highly
correlated with venous thromboembolism (R2 = 0.93). For the
Rogers score, only 0.2% of patients were low risk (score <7), 36.9%
were medium risk (score 7–10), and 63.0% were high risk (score >10).
When the highest risk group of the Rogers score was substratified, it
was also highly correlated with venous thromboembolism (R2 = 0.99).
Conclusion
Gynecological
oncology patients score very high on current venous thromboembolism
risk assessment models. The Caprini score is limited in its ability to
discriminate relative venous thromboembolism risk among gynecological
oncology patients because 97% are in the highest-risk category.
Substratification of the highest-risk groups allows for relative venous
thromboembolism risk stratification among gynecological oncology
patients, suggesting that further evaluation of risk stratification is
needed in gynecological oncology surgery.
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