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FEASIBILITY STUDY OF THE CAPRINI RISK SCORING SYSTEM

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FEASIBILITY STUDY OF THE CAPRINI RISK SCORING SYSTEM

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  1. 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

  2. Surrey Memorial Hospital • Located in Surrey, British Columbia, Canada • Close to 500 beds • Busiest ER in BC with over 93 000 visits per year

  3. 2010 ACS NSQIP Conference • Dr Joseph A Caprini’s presentation on DVT • Demonstrated efficacy of his risk scoring system • Can be contacted at jcaprini2@aol.com

  4. 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

  5. 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”

  6. 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

  7. 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

  8. 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

  9. Results

  10. Receiver Operation Characteristic Curve Optimal specificity & sensitivity at score of 6 All Made Using STATA Statistically Significant Area under curve is 81%, therefore this is a good test

  11. 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 #

  12. Limitations • Affordability • Did not use “other risk factors” • Phone survey • Blood Work • Scores are too low

  13. 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

  14. 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: trevor_gill@sfu.ca