Risk Assessment Models for Venous Thromboembolism in Patients Undergoing Plastic Surgery: A Systematic Review and Meta-Analysis

Abstract

Introduction: The validity and predictive capability of risk assessment models (RAMs) in evaluating venous thromboembolism (VTE) risk in patients undergoing plastic surgery procedures is not well established. We pooled all available studies to establish this validity and compare the predictive capability of the various RAMs. Materials and Methods: We perused Pubmed, MEDLINE and Embase from their inception up until December 2021 for studies evaluating VTE incidence in populations of plastic surgery patients stratified into risk categories by pertinent RAMs. Data was pooled using random-effect models. Results: Nine studies, totaling 1,356,822 patients, were eligible for analysis. We included 2 RAMS in our study, Caprini risk score and ASA score. Results showed that patients in higher Caprini risk categories tended to present with significantly more VTE incidents, with super-high risk patients being more susceptible than high risk patients (OR 2.73; 95% CI 1.65–4.52; P < 0.0001) and high risk patients being more susceptible than medium risk patients (OR 2.20; 95% CI 1.31–3.67; P = 0.003). Medium risk patients, however, were not at demonstrably higher risk of VTE events than their low risk counterparts (OR 1.17; 95% CI 0.85–1.60; P = 0.34). Patients evaluated to be at high risk by the ASA score also presented with a greater number of VTE incidents than those evaluated to be at low risk (OR 2.72; 95% CI 1.10–6.72; P = 0.03). Conclusion: Both Caprini and ASA scores are good predictors of VTE incidents in plastic surgery populations. Larger studies with longer follow-up times are required to validate our results.