The Value Of Different Versions Of Caprini Risk Assessment Model In Gynecologic Surgery Patients

objective:venous thromboembolism(VTE) is a common clinical complication.Assessment of VTE risk is an essential and important step of VTE prophylaxis. Caprini risk assessment model(RAM) is an widely used VTE risk assessment tool home and abroad.This research is to explore the predictive capacity of the 2005 and 2009 Caprini RAM for perioperative period VTE risk and analyze the perioperative period VTE epidemiology in gynecologic surgery patients in order to provide evidence for the option of VTE RAM and VTE prophylaxis.Method: A total of 1471 patients accepted surgery in the department of gynecology in The second hospital of Lanzhou university from March,2013 to March,2015 were enrolled in this study.Clinical materials of these patients were collected and VTE risk score and risk level of each patient was respectively assessed by 2005 and 2009 version Caprini RAM.The characteristics of VTE patients and VTE rate in each VTE risk level were analyzed.VTE rate in different risk level of each version of Caprini RAM and in the same risk level in different versions of Caprini RAM were compared. All data was analyzed by SPSS 19.0 software.Results:1.There are 21 DVT and no PTE patients in the enrolled patients.One DVT happened 7days before surgery and the others in 1 to 27 days after surgery.The DVT patients are consist of 10 benign uterus disease patients,5 endometrial cancer patients,3 ovarian cancer patients and 3primary peritoneal cancer patients.2.The total DVT rate are 1.43% in perioperative period.The DVT rate is 0.87% in benign disease group and 3.46% in malignant disease group.It is 4.63% in endometrial cancer,3.66% in ovarian cancer and 33.33%(3/9) in primary peritoneal cancer(P<0.05).3.The median score assessed by 2005 Caprini RAM is 5 points.Patients who got 0 to 1 point account for 0%,2 point account for 1.3%,3 to 4 points account for 18.6%,5 to 6 points account for62.5%,7 to 8 points account for 13.9%,more than 8 points account for 3.7%.And none in 2point,0.7% patients in 3-4 points,0.8% patients in 5-6 points,5.4% patients in 7-8 points and 1.8%in more than 8 points got DVT. All the DVT patients were scored more than 2 points which represents high and highest risk by 2005 Caprini RAM.4.The median score assessed by 2009 Caprini RAM is 4 points.Patients who got 0 to 1 pointaccount for 0%,2 points account for 3.3%,3 to 4 points account for 61%,5 to 6 points account for35.6%,7 to 8 points account for 6.5%,more than 8 points account for 15.4%.The difference is statistically significant(P<0.05).And 2.0% patients in 2 points,0.9% patients in 3-4 points,0% in5-6 points,3.2% patients in 7-8 points and 4.0% in more than 8 points got DVT.The difference is statistically significant(P<0.05).All the DVT patients were scored 2 to 12 points which represents moderate,high and highest risk by 2009 Caprini RAM.5.DVT rate in the same risk score level between different Caprini RAM is not statistically significant(P>0.05).Conclusion:1.The symptomatic DVT rate is 1.43% in patients accepted gynecologic surgeries.And the rate in patients who experienced malignancies is higher than patients who experienced benign diseases(3.46%vs0.87%).2.According to Caprini RAM,the VTE risk of gynecological surgery patients is at least belong to moderate risk and physical or pharmacological prophylaxis should be given.3.The DVT rate rises with growth of score level and all DVT patients were stratified to high and highest risk while using the 2005 Caprini RAM but the DVT rate is not risen with growth of score level and all DVT patients were stratified to moderate,high and highest risk while using the2009 Caprini RAM. The 2005 Caprini RAM is the more appropriate VTE RAM for perioperative period gynecologic surgery patients.The 2009 Caprini RAM is not a appropriate VTE RAM for perioperative period gynecologic surgery patients unless more convictive researches available.