The Limited Utility of Currently Available Venous Thromboembolism Risk Assessment Tools in Gynecologic Oncology Patients. - PubMed - NCBI

abstract

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 (VTE) risk and guide prophylaxis. However, these tools were not developed in a gynecologic oncology patient population and their utility in this population is unknown.

OBJECTIVE:

To examine the ability of both the Caprini and Rogers score to stratify gynecologic oncology patients by risk of VTE.
 

CONCLUSIONS:

Gynecologic oncology patients score very high on current VTE risk assessment models. The Caprini score is limited in its ability to discriminate relative VTE risk among gynecologic oncology patients as 97% are in the highest-risk category. Sub-stratification of the highest risk groups allows for relative VTE risk stratification among gynecologic oncology patients suggesting that further evaluation of risk stratification is needed in gynecologic oncology surgery.

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 Database using ICD-9 codes. Caprini and Rogers scores were calculated for each patient based upon recorded demographic and procedure data. VTE events were recorded for 30 days postoperatively. Patients were categorized into risk groups based on calculated Caprini and Rogers scores and the incidence of VTE and 95% confidence interval was estimated for each of these groups. The relationship between risk score and VTE incidence was examined with Pearson's correlation coefficient.

RESULTS:

Of 17,713 patients, 1.8% developed a VTE. 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 VTE. The high-risk group had a paradoxically higher incidence of VTE of 2.5% compared to the highest risk group, 1.7% (p=0.40). However, when the highest risk group of the Caprini score was sub-stratified, it was highly correlated with VTE (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 sub-stratified, it was also highly correlated with VTE (R²=0.99).

CONCLUSIONS:

Gynecologic oncology patients score very high on current VTE risk assessment models. The Caprini score is limited in its ability to discriminate relative VTE risk among gynecologic oncology patients as 97% are in the highest-risk category. Sub-stratification of the highest risk groups allows for relative VTE risk stratification among gynecologic oncology patients suggesting that further evaluation of risk stratification is needed in gynecologic oncology surgery.