A modified Caprini risk assessment model (RAM) was a better predictor of which patients were at elevated risk for postoperative venous thromboembolism (VTE), according to results of a multicenter, observational, cross-sectional cohort study. These findings were published in the Journal of Surgical Oncology.
The rate of postoperative VTE in patients undergoing surgical intervention for lung cancer is as high as 15.2%. To evaluate whether additional features may improve risk prediction, 1205 patients undergoing surgery for lung cancer in 2016-2019 were recruited at 6 sites in China. All patients were screened using the Caprini RAM and a modified scoring system with additional factors and assessed for postoperative VTE.
Patients were aged 59.8±9.8 years, 52.0% were women, participants’ BMI was 24.0±3.3 kg/m2, 84.1% underwent video-assisted thoracic surgery, and 81.0% had adenocarcinoma.
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Overall, 87 patients (7.2%) developed VTE, with 81 (6.7%) developing deep vein thrombosis and 5 (0.4%) developing pulmonary embolism. In 1 patient, both conditions were diagnosed at the same time. The incidence decreased over time, from 16.9% in 2016 to 3.9% in 2019 (P <.001).
Risk for postoperative VTE was associated with diabetes (odds ratio [OR], 2.640; P =.045), female sex (OR, 1.326; P <.001), duration of operation (OR, 1.258; P =.012), length of hospital stay (OR, 1.075; P <.001), and age (OR, 1.063; P <.001).
The original Caprini RAM classified 4.4% of patients as high risk, whereas the modified Caprini RAM classified 23.9% of patient as high risk (incidence of VTE was 11.3% and 19.1%, respectively, in the 2 subgroups). Modifying the Caprini RAM to include elevated D-dimer levels and surgical time increased the area under the receiver‐operating characteristic curve from 0.589 to 0.759 (P <.05).
A risk cutoff for the modified Caprini RAM had a prediction of VTE among those with a score of 9 with a sensitivity of 63.2%, specificity of 79.2%, positive predictive value of 19.1%, and negative predictive value of 96.5%.
The study authors concluded that a modified Caprini RAM was a more accurate predictor of postsurgical VTE among patients with lung cancer. This study was limited by assessing for VTE during hospitalization, whereas risk for VTE remains after hospital discharge.
Reference
Ke L, Cui S, Yang M, et al. Validation of a modified Caprini risk assessment model in lung cancer patients undergoing surgery: results of a multicenter cross‐sectional observational study. J Surg Oncol. Published online January 18, 2022. doi:10.1002/jso.26794
