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 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

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” 7/05-6/061/06-12/067/06-6/071/07-12/077/07-6/081/08-12/087/08-6/091/09/12/09 DVT PE O/E L

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

Results Risk Level Lowest Risk Moderate Risk Higher Risk Highest Risk

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

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 #

Limitations Affordability Did not use “other risk factors” Phone survey Blood Work Scores are too low Score ≥ % of Patients % % % %

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: