A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital
Background: Patients undergoing total joint arthroplasty (TJA) are at increased risk for venous thromboembolism (VTE). Prediction tools such as the Caprini Risk Assessment Model (RAM) have been developed to identify patients at higher risk. However, studies have reported heterogeneous results when a...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-10-01
|
| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344123000997 |
| _version_ | 1797653996218875904 |
|---|---|
| author | Brian Gibbs, MD Samuel Paek, BS Noelle Wojciechowski, BA Sean Wrenn, BS David M. Freccero, MD Ayesha Abdeen, MD |
| author_facet | Brian Gibbs, MD Samuel Paek, BS Noelle Wojciechowski, BA Sean Wrenn, BS David M. Freccero, MD Ayesha Abdeen, MD |
| author_sort | Brian Gibbs, MD |
| collection | DOAJ |
| description | Background: Patients undergoing total joint arthroplasty (TJA) are at increased risk for venous thromboembolism (VTE). Prediction tools such as the Caprini Risk Assessment Model (RAM) have been developed to identify patients at higher risk. However, studies have reported heterogeneous results when assessing its efficacy for TJA. Patients treated in an urban health safety net hospital have increased medical complexity, advanced degenerative joint disease, and severe disability prior to TJA increasing the risk of VTE. We hypothesize that use of a tool designed to account for these conditions—the Boston Medical Center (BMC) VTE score—will more accurately predict VTE in this patient population. Methods: A retrospective case-control study was performed including subjects 18 years of age and older who underwent primary or revision TJA in an urban academic health safety net hospital. Patients with hemiarthroplasties, simultaneous bilateral TJA, and TJA after acute trauma were excluded. A total of 80 subjects were included: 40 who developed VTE after TJA (VTE+) and 40 who did not develop VTE (controls). Subjects were matched by age, gender, and surgical procedure. Results: There was a statistically significant difference between the mean BMC VTE score for VTE+ and controls (4.40 and 3.13, respectively, P = .036). Conversely, there was no statistical difference between the mean Caprini scores for VTE+ and controls (9.50 and 9.35, respectively, P = .797). Conclusions: In a health safety-net patient population, an institutional RAM—the BMC VTE score—was found to be more predictive of VTE than the modified Caprini RAM following TJA. The BMC-VTE score should be externally validated to confirm its reliability in VTE prediction in similar patient populations. |
| first_indexed | 2024-03-11T16:52:57Z |
| format | Article |
| id | doaj.art-fd09d004a69347079b775be7172947c5 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-03-11T16:52:57Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-fd09d004a69347079b775be7172947c52023-10-21T04:22:46ZengElsevierArthroplasty Today2352-34412023-10-0123101194A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net HospitalBrian Gibbs, MD0Samuel Paek, BS1Noelle Wojciechowski, BA2Sean Wrenn, BS3David M. Freccero, MD4Ayesha Abdeen, MD5Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USAGeisinger Commonwealth School of Medicine, Scranton, PA, USABoston University School of Medicine, Boston, MA, USABoston University School of Medicine, Boston, MA, USADepartment of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USADepartment of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA; Corresponding author. Department of Orthopaedic Surgery, Boston Medical Center, 85 E. Concord St, 4th Floor, Boston, MA 02118, USA. Tel.: +1 617 638 5633.Background: Patients undergoing total joint arthroplasty (TJA) are at increased risk for venous thromboembolism (VTE). Prediction tools such as the Caprini Risk Assessment Model (RAM) have been developed to identify patients at higher risk. However, studies have reported heterogeneous results when assessing its efficacy for TJA. Patients treated in an urban health safety net hospital have increased medical complexity, advanced degenerative joint disease, and severe disability prior to TJA increasing the risk of VTE. We hypothesize that use of a tool designed to account for these conditions—the Boston Medical Center (BMC) VTE score—will more accurately predict VTE in this patient population. Methods: A retrospective case-control study was performed including subjects 18 years of age and older who underwent primary or revision TJA in an urban academic health safety net hospital. Patients with hemiarthroplasties, simultaneous bilateral TJA, and TJA after acute trauma were excluded. A total of 80 subjects were included: 40 who developed VTE after TJA (VTE+) and 40 who did not develop VTE (controls). Subjects were matched by age, gender, and surgical procedure. Results: There was a statistically significant difference between the mean BMC VTE score for VTE+ and controls (4.40 and 3.13, respectively, P = .036). Conversely, there was no statistical difference between the mean Caprini scores for VTE+ and controls (9.50 and 9.35, respectively, P = .797). Conclusions: In a health safety-net patient population, an institutional RAM—the BMC VTE score—was found to be more predictive of VTE than the modified Caprini RAM following TJA. The BMC-VTE score should be externally validated to confirm its reliability in VTE prediction in similar patient populations.http://www.sciencedirect.com/science/article/pii/S2352344123000997Venous thromboembolismDeep vein thrombosisPulmonary embolismTotal knee arthroplastyTotal hip arthroplastyRisk prediction tool |
| spellingShingle | Brian Gibbs, MD Samuel Paek, BS Noelle Wojciechowski, BA Sean Wrenn, BS David M. Freccero, MD Ayesha Abdeen, MD A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital Arthroplasty Today Venous thromboembolism Deep vein thrombosis Pulmonary embolism Total knee arthroplasty Total hip arthroplasty Risk prediction tool |
| title | A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital |
| title_full | A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital |
| title_fullStr | A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital |
| title_full_unstemmed | A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital |
| title_short | A Comparison of the Caprini Score With an Institutional Risk Assessment Tool for Prediction of Venous Thromboembolism After Total Joint Arthroplasty at an Urban Tertiary Care Health Safety Net Hospital |
| title_sort | comparison of the caprini score with an institutional risk assessment tool for prediction of venous thromboembolism after total joint arthroplasty at an urban tertiary care health safety net hospital |
| topic | Venous thromboembolism Deep vein thrombosis Pulmonary embolism Total knee arthroplasty Total hip arthroplasty Risk prediction tool |
| url | http://www.sciencedirect.com/science/article/pii/S2352344123000997 |
| work_keys_str_mv | AT briangibbsmd acomparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT samuelpaekbs acomparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT noellewojciechowskiba acomparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT seanwrennbs acomparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT davidmfrecceromd acomparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT ayeshaabdeenmd acomparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT briangibbsmd comparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT samuelpaekbs comparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT noellewojciechowskiba comparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT seanwrennbs comparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT davidmfrecceromd comparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital AT ayeshaabdeenmd comparisonofthecapriniscorewithaninstitutionalriskassessmenttoolforpredictionofvenousthromboembolismaftertotaljointarthroplastyatanurbantertiarycarehealthsafetynethospital |