Caprini Score Compliance and Changes in Practice Patterns at an Academic Urological Practice
Egor Parkhomenko, MD, Daniel Leslie, MD, Keianna Vogel, BSc, Mark Katz, MD, Shaun Wason, MD, David Wang, MD.
Boston Medical, Boston, MA, USA.
The Caprini score (CS) accurately predicts those at risk of a venous thromboembolism (VTE) and determines the duration prophylaxis (ppx). The American Urological Association acknowledges high risk individuals and recommends inpatient VTE ppx but fails to provide clear guidelines for outpatient ppx. We sought to assess the practice patterns of urologists prescribing VTE ppx in the post-operative setting for major urological cases after a hospital wide mandate to utilize the CS.
Methods & Methods:
A retrospective chart review after institutional review board approval identified patients that had a (robotic, open, or laparoscopic) partial nephrectomy (n = 247) and a (robotic) prostatectomy (n = 317) at an academic medical center from the year 2014-2020. Basic demographic, clinical, operative, and anticoagulation data was collected.
Partial nephrectomy patients had a CS of 5.3 (range 2-19), inpatient VTE ppx was used 99% of the time, and readmission rate was 12.6% (Table 1). In 2 years since CS implementation, >50% of patients were assigned a CS, and in 4 years >50% with a CS of >4 received VTE ppx (Figure 1). Prostatectomy patients had a CS of 6.0 (range 1-10), inpatient VTE ppx was used 97.5% of the time, and readmission rate was 2.2%. In 2 years since CS implementation, >50% of patients were assigned a CS, and in 3 years >50% of patients with a CS of >4 received VTE ppx. No correlation was found between VTE ppx for patients with CS >4 and the readmission rates for partial nephrectomy or prostatectomy patients (r= 0.526, p = 0.23 and r= 0.107, p = 0.82, respectively).
Compliance with national guidelines for inpatient thromboprophylaxis remains high. The Caprini scoring system takes 4 years after a hospital wide mandate to translate into clinical practice while readmission rates remain stable.
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