FEASIBILITY STUDY OF
THE CAPRINI RISK
SCORING SYSTEM
DVT/PE MANAGEMENT IN CANADA'S PUBLICLY
FUNDED HEALTHCARE SYSTEM
Trevor Gill
Peter Doris MD
Angela Tecson RN
Surrey Memorial Hospital
 Located in Surrey, British
Columbia, Canada
 Close to 500 beds
 Busiest ER in BC with
over 93 000 visits per
year
2010 ACS NSQIP Conference
 Dr Joseph A Caprini’s presentation on DVT
 Demonstrated efficacy of his risk scoring system
 Can be contacted at [email protected]
DVT/PE in Our Hospital
 Though our Hospital is in the “as expected” category we
feel through better use of prophylaxis we can become
“exemplary” while save the hospital money
Initial Review
 After Dr Caprini’s presentation we
investigated DVT/PE at SMH using
NSQIP data
 Examined O/E – was “as expected”
 One “Moderate Risk” case, the rest
“Highest” or “Higher Risk”
DVT/VTE Review
ID Score
Risk
1473
9
Highest Risk
1491
9
Highest Risk
3070
6
Highest Risk
3207
8
Highest Risk
3223
10
Highest Risk
4573
9
Highest Risk
5505
12
Highest Risk
5675
6
Highest Risk
5752
6
Highest Risk
1798
7
Highest Risk
2484
4
High Risk
3269
8
Highest Risk
3499
8
Highest Risk
3683
5
Highest Risk
3710
2
Moderate Risk
4155
8
Highest Risk
4892
4
High Risk
5325
7
Highest Risk
5528
5
Highest Risk
Jan 1, 2007 – Mar 31, 2010
• 19 DVT/PE Cases
• 3/19 (16%) RTO
• 2/19 (10.5%) Died
7/05-6/06 1/06-12/06 7/06-6/07 1/07-12/07 7/07-6/08 1/08-12/08 7/08-6/09 1/09/12/09
DVT PE
O/E
0.2
0.35 L
0.75
0.58
0.37
0.9
0.74
0.48
Caprini Scoring System
 Risk scoring system for
calculating risk of
post-op DVT/PE
 Different risk criteria
count for different
points
 Patient assigned to risk
group based on score
What does it cost?
 DVT/PE costs us $5393 & $7631 respectively*
 Large percentage patients in highest risk category
 Too expensive to give them all 30 day prophylaxis
 Goals of study:
 To identify a cut-off Caprini score for very high risk
patients.
 Use data to demonstrate high risk patients require 30 day
prophylaxis
*Before Physician Wages – From the Canadian Institute for Health Information
Retrospective Analysis
 To further support implementation of Caprini we
conducted a retrospective study
 Calculate Caprini scores using multiple data sources: EMR,
NSQIP data & Phone Survey
 Study focuses on patients from Jan 2006 to May 2011
 Calculate patient Caprini scores
 Conducted phone survey
Caprini Score Distribution of DVT/PE
Positive Patients
Results
Number of Patients
4
3
2
1
0
1
2
3
Caprini Score Distribution of All
Patients
800
719
Number of Patients
581
600
400
300
200
100
263
6
7
8
9 10
Caprini Score
11
12
13
Lowest Risk
445
500
5
Risk Level
655
700
4
Moderate Risk
284
182
100
Higher Risk
75
60
49
22
11
6
7
1
1
0
0
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Caprini Score
Highest Risk
14
15
16
Receiver Operation Characteristic Curve
All Made Using
STATA
Statistically Significant
Optimal specificity &
sensitivity at score of 6
Area under curve is 81%,
therefore this is a good test
Time Series
 Many DVT/PE occurring
after prophylaxis ended
 It is necessary to continue
post-op prophylaxis
beyond what we currently
do
Days Post-Op
Case
#
Number of Patients
Days Post-Op Until DVT/PE Event
7
6
5
4
3
2
1
0
0-4
5-9
10-14
15-19
Days
20-24
25-30
Limitations
 Affordability
 Did not use “other risk factors”
 Phone survey
 Blood Work
 Scores are too low
Score ≥
% of Patients
6
24.49%
7
15.79 %
8
10.21 %
9
7.14 %
The next step…
 Network with preadmissions and anesthesia to obtain
the needed patient data and ensure accuracy
 Discussion with anti-coagulation clinic
 Revisit study & recalculate cutoff
 Calculate “numbers needed to treat”
 Examine potential cost savings from 30 day prophylaxis
Acknowledgements
 Thanks again to Dr Joseph Caprini for his ongoing support
 Special thanks to the SMH Director of Surgical Programs
Lorraine Gillespie
 Thank you to my co-authors
 Dr Peter Doris, Surgeon Champion, Chief of Surgery at SMH
 Angela Tecson, SCR
 Contact: [email protected]