New England Surgical Society

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Venous Thromboembolism Prophylaxis in Patients Undergoing Breast Surgery
*Na Eun Kim1, *Liam Conway-Pearson2, *Kevin Bachrach2, *Maureen T Kavanah1, *Jane E Mendez3, *Teviah E Sachs1, *Thurston F Drake1, David McAneny1, *Michael R Cassidy1
1Boston Medical Center, Boston, MA;2Boston University School of Medicine, Boston, MA;3Baptist Health South Florida, Miami, FL

Objective To evaluate compliance with and outcomes of a standardized venous thromboembolism (VTE) risk assessment and prophylaxis program, based on the Caprini model, for patients undergoing breast operations.
Design Retrospective descriptive study.
Setting: Academic urban safety net and tertiary referral hospital.
Patients Patients who underwent breast operations between 2011 and 2018, including local excision, partial, total or modified radical mastectomy with and without reconstruction.
Interventions A mandatory standardized VTE risk assessment program, using the Caprini model, was implemented in 2011, along with corresponding risk-stratified prophylaxis regimens. Extended chemoprophylaxis (ECP) beyond discharge is recommended for high and highest-risk patients; surgeons may decline this option.
Main Outcome Measure VTE, bleeding events, and adherence to recommended prophylaxis.
Results Of 913 patients, 49.3% were categorized as low or moderate VTE risk, 43.6% were high-risk, and 7.1% were highest-risk. There were 6 VTE events, including 5 in the high-risk group, and 1 in the highest-risk group. One patient was diagnosed with VTE during the index admission. Five patients manifested VTEs after discharge, none of them had been prescribed ECP, contrary to protocol guidelines. Among patients in the high and highest risk category, 20.9% and 59.7%, respectively, were given ECP. Twenty bleeding events were managed non-operatively; only 3 patients required re-explorations. The overall incidence of bleeding was 2.04%, consistent with reported rates. No difference in bleeding complications was detected.
Conclusions The Caprini protocol can identify a subset of patients who may benefit from ECP after breast operations, as well as those who require no chemoprophylaxis.

Table 1: Complications by Caprini Score
Type of ComplicationLow/Moderate Risk (n=434)High Risk (n=383)Highest Risk (n=62)Total% Total Patients
Patients discharged with ECP2 (0.5%)80 (20.9%)37 (59.7%)
Bleeding- no evacuation7112201.78%
Bleeding- wound re-exploration03030.27%
Surgical Site Infection13123332.93%
Wound Complication462131.15%
VTE: venous thromboembolismECP: Extended Chemoprophylaxis

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