Background The VTEPS Network is normally a consortium of five tertiary
May 30, 2017
Background The VTEPS Network is normally a consortium of five tertiary recommendation centers established to examine venous thromboembolism in cosmetic surgery sufferers. Dependent variables included symptomatic DVT or PE inside the initial 60 post-operative period and times to DVT or PE. NVP-AEW541 Results We discovered 1126 historical control sufferers. The entire VTE occurrence was 1.69%. Around one in nine (11.3%) sufferers with Caprini rating >8 had a VTE event. Sufferers with Caprini rating >8 were a lot more more likely to develop VTE in comparison with sufferers with Caprini rating of 3-4 (OR 20.9 p<0.001) 5 (OR 9.9 p<0.001) or 7-8 (OR 4.6 p=0.015). Among sufferers with Caprini score 7-8 or Caprini score >8 VTE risk was not limited to the immediate post-operative period. Conclusions The Caprini RAM effectively risk-stratifies plastic and reconstructive surgery patients for VTE risk. Among patients with Caprini score >8 11.3% have a post-operative VTE when chemoprophylaxis is not provided. In higher risk patients there was no evidence that VTE risk is limited to the immediate post-operative period. INTRODUCTION Venous thromboembolism (VTE) is a disorder with short-term mortality and long-term morbidity. VTE has been deemed a major threat to patient safety by policymakers and payers including the US Surgeon General (1) the Centers for Medicare and Medicaid Services (2) and the NVP-AEW541 National Quality Forum (3). To fully identify VTE risk in surgical patients recent publications advocate individualized patient risk assessment (4-7). The Caprini Risk Assessment Model (RAM) was derived over a decade ago based on a combination of clinical experience and published data (8-10). More recently the Caprini RAM has been validated for 30-day VTE events in a large series of general urology and vascular surgery patients (5). Revised versions of the model have also been validated in post-bariatric body contouring patients (7) and medical inpatients (11 12 Plastic NVP-AEW541 and reconstructive surgery patients are known to be at high risk for venous thromboembolism after surgery. Symptomatic VTE occurs with high frequency after post-bariatric body contouring surgery including circumferential abdominoplasty (7.7%) abdominoplasty (5.0%) and breast or upper body contouring (2.9%) procedures (7). Using the modified Davison-Caprini RAM (13) Seruya and colleagues showed a 7.5% VTE incidence in patients stratified to the “highest risk” group (14). Symptomatic post-operative VTE occurs in 2.2% of women having flap-based breast reconstruction after mastectomy (15). However asymptomatic VTE rates NVP-AEW541 in the flap-based breast reconstruction population may be much higher. A recent study screened asymptomatic women prior to discharge using duplex ultrasound and demonstrated that 4% had occult DVT (16). In addition a small case series demonstrated that 16.7% of women may have occult PE within 3 days of surgery (17). The Venous Thromboembolism Prevention Study (VTEPS) was funded by the Plastic Surgery Educational Foundation in 2008. The study’s primary objective is to examine the effectiveness of post-operative enoxaparin (Lovenox? Sanofi Aventis) for prevention of symptomatic VTE Sele events in a diverse population of adult plastic and reconstructive surgery patients. The study’s control group is comprised of historic control patients who had plastic and reconstructive surgery but did not receive post-operative heparin low-molecular weight heparin anti-factor Xa medications or warfarin (collectively referred to as “chemoprophylaxis”). In this initial analysis of the VTEPS data we sought to examine VTE incidence and when VTE events occur after plastic surgery. In addition we examined the ability from the Caprini RAM to risk-stratify reconstructive and cosmetic surgery individuals. Analyses were limited by VTEPS control individuals non-e of whom received chemoprophylaxis. Strategies Study style VTEPS has been carried out at five tertiary treatment facilities in america. The analyses referred to below were limited by data through the VTEPS historical control group. Historical control individuals were determined using medical record review for many plastic material and reconstructive medical procedures instances performed at each of five VTEPS sites between January 2006 and June 2009. Historical control eligibility requirements included moderate to risky for VTE (Caprini rating ≥3) procedure under general anesthesia and over night medical center stay. Control individuals did not get heparin low-molecular pounds heparin (LMWH) point Xa.