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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2018

01-11-2018 | Breast Oncology

Implementation of a Venous Thromboembolism Prophylaxis Protocol Using the Caprini Risk Assessment Model in Patients Undergoing Mastectomy

Authors: Alison Laws, MD, Kathryn Anderson, PA, Jiani Hu, MPH, Kathleen McLean, PA, Lara Novak, PA, Laura S. Dominici, MD, Faina Nakhlis, MD, Matthew Carty, MD, Stephanie Caterson, MD, Yoon Chun, MD, Margaret Duggan, MD, William Barry, PhD, Nathan Connell, MD, MPH, Mehra Golshan, MD, Tari A. King, MD

Published in: Annals of Surgical Oncology | Issue 12/2018

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Abstract

Background

Guidelines for venous thromboembolism (VTE) prophylaxis are not well-established for breast surgery patients. An individualized VTE prophylaxis protocol using the Caprini score was adopted at our institution for patients undergoing mastectomy ± implant-based reconstruction. In this study, we report our experience during the first year of implementation.

Methods

In August 2016, we adopted a VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction. We used the Caprini score, a validated risk assessment tool for VTE, to determine each patient’s perioperative prophylaxis regimen. Detailed chart review was performed to record patient and treatment details, the Caprini score, pharmacologic VTE prophylaxis administration, and 30-day incidence of VTE and bleeding complications. We performed univariate analysis to identify factors associated with protocol compliance.

Results

Overall, 522 patients met the inclusion criteria. Median age was 51 years, 486 (93.1%) patients had malignancy, 234 (44.8%) underwent bilateral mastectomy, and 350 (67.0%) underwent reconstruction. Caprini scores ranged from 2 to 11, with 431 (82.6%) patients having a score from 5 to 7. Overall protocol compliance was 60.5%, and was associated with bilateral mastectomy (p = 0.02), reconstruction (p = 0.03), and longer procedures (p < 0.001). The rate of VTE was 0.2% (95% confidence interval [CI] 0.03–1.1%), rate of reoperation for hematoma was 2.7% (95% CI 1.6–4.5%), and rate of blood transfusion was 0.4% (95% CI 0.1–1.4%).

Conclusions

The implementation of an individualized VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction is safe and feasible. Despite a high-risk cohort, the incidence of VTE was very low and bleeding complications were consistent with reported rates for breast surgery. Continued evaluation of this strategy is warranted.
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Metadata
Title
Implementation of a Venous Thromboembolism Prophylaxis Protocol Using the Caprini Risk Assessment Model in Patients Undergoing Mastectomy
Authors
Alison Laws, MD
Kathryn Anderson, PA
Jiani Hu, MPH
Kathleen McLean, PA
Lara Novak, PA
Laura S. Dominici, MD
Faina Nakhlis, MD
Matthew Carty, MD
Stephanie Caterson, MD
Yoon Chun, MD
Margaret Duggan, MD
William Barry, PhD
Nathan Connell, MD, MPH
Mehra Golshan, MD
Tari A. King, MD
Publication date
01-11-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6696-y

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