Key result
High Caprini score links to increased intraoperative transfusions and longer stays in free flap reconstruction.
Why the study?
Prior studies assessing the Caprini Risk Score to predict complications in free flap reconstruction were confounded by small sample sizes, varying surgical sites, and disparate risk classifications.
Does a high Caprini Risk Score predict complications in patients undergoing free flap reconstruction?
Cohort (n=502)
Does a high Caprini Risk Score predict complications in patients undergoing free flap reconstruction?
The Caprini Risk Score may help predict the need for blood transfusions and anticoagulation requirements in free flap reconstruction, but it does not appear to predict flap complications or VTE in this cohort.
Answers are grounded in this paper and cite their sources.
CRS may flag transfusion and anticoagulation needs but not flap complications; leaves open VTE prediction utility pending prospective validation.
Venous thromboembolism (VTE) is considered a complication of free flap surgery. Prior studies investigating the use of the Caprini Risk Score (CRS) to estimate the risk of complications in free flap reconstruction are confounded by small sample sizes, varying surgical sites, and disparate classification of risk. This study evaluates the predictive merit of CRS for complications in free flap reconstructions. A retrospective review of patients (n = 502) who underwent free flap reconstruction from January 2015 to April 2022 collected patient medical history, type and location of free tissue transfer, CRS, and prior and perioperative anticoagulation (AC). Reconstructive outcomes and complications were analyzed in low (CRS <8) and high (CRS ≥8) cohorts using chi-square tests. Complications were also analyzed by flap sites in sufficient cohort populations (n > 10). Of 502 patients, the high CRS cohort (n = 71) was associated with upper (p < 0.005) and lower (p < 0.001) extremity reconstructions while the low CRS (n = 431) cohort was associated with breast reconstructions (p < 0.001). The high CRS cohort demonstrated an increased need for intraoperative blood transfusions (p < 0.001). Other intraoperative or postoperative complications such as flap loss, intraoperative AC, return to operating room (OR), or VTE had no significant correlations. High CRS patients were more likely to be discharged on AC (p < 0.001) and have a longer length of stay (LOS; p < 0.001). By flap site, there was a significant association between CRS and LOS >14 days in breast and head and neck flaps (p < 0.05) and discharge on AC in head and neck flaps only (p < 0.001). CRS may have utility in predicting the need for blood transfusion and AC requirements in free flap reconstruction but does not seem to predict the incidence of flap complications. A larger, higher-powered study may be used to assess the validity of CRS in risk of VTE and anticoagulant prophylaxis.
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Khaw et al. (2025) conducted a cohort in Free flap reconstruction (n=502). High Caprini Risk Score (CRS ≥8) vs. Low Caprini Risk Score (CRS <8) was evaluated on Complications in free flap reconstructions. A high Caprini Risk Score (≥8) in free flap reconstruction was significantly associated with an increased need for intraoperative blood transfusions (p<0.001) and longer length of stay (p<0.001).
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