Abstract
INTRODUCTION: Venous thromboembolism (VTE) is a significant cause of postoperative morbidity, mortality, and cost. Although the risk is low in minimally invasive gynecologic surgery, risk-based prophylaxis is recommended. The modifed Caprini score (CS) can assess risk of VTE and inform preoperative and postoperative prophylaxis. We assessed whether formal implementation of the CS in the Department of Minimally Invasive Gynecologic Surgery at a large academic center affected preoperative and postoperative VTE prophylaxis prescribing patterns. METHODS: Institutional review board exemption was obtained. A sample of 356 patients (156 in pre-implementation group and 190 in post-implementation group) undergoing presumed benign minimally invasive hysterectomy or myomectomy between October 2021 and September 2022 was retrospectively analyzed. The primary outcome investigated was adherence to recommended preoperative prophylaxis before and after implementation. Secondary outcomes included incidence of VTE and concern for bleeding. RESULTS: Patient demographics, VTE risk factors, CS, and surgical details were determined to be statistically comparable between the groups. The implementation of CS significantly improved preoperative VTE prophylaxis recommendation adherence from 65.4% to 85.2% (P<.001). This was due to both an increase in indicated pharmacologic prophylaxis, as well as a decrease in nonindicated usage in low-risk patients (from 22.4% to 2.6%). VTE risk was similarly low in both groups, occurring in only one patient from the pre-implementation group. There was no significant difference in estimated blood loss. CONCLUSION: These results suggest that CS use in patients undergoing minimally invasive gynecologic surgery can improve adherence to recommended preoperative prophylaxis for VTE, while decreasing unnecessary overtreatment in low-risk patients.
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