Key result
The Caprini score demonstrated poor discriminatory ability for predicting postoperative venous thromboembolism in patients with metastatic spine disease (AUC 0.56; 95% CI 0.44-0.58; p=0.32).
Why the study?
No standardized risk stratification framework exists to guide prophylaxis for perioperative VTE in metastatic spine disease patients, and the applicability of the Caprini score in this population remains uncertain.
Does the Caprini score predict postoperative venous thromboembolism in adult patients with metastatic spine disease undergoing surgery?
Cohort (n=336)
Does the Caprini score predict postoperative venous thromboembolism in adult patients with metastatic spine disease undergoing surgery?
Effect estimate: AUC 0.56 (95% CI 0.44-0.58)
p-value: p=0.32
The Caprini score has limited clinical utility for predicting postoperative venous thromboembolism in patients with metastatic spine disease due to uniformly elevated baseline risk.
Caprini score lacks utility for VTE prediction after metastatic spine surgery; challenges generalizability and leaves open need for tailored models.
Background Metastatic spine disease (MSD) patients are at elevated risk for perioperative venous thromboembolism (VTE), yet no standardized risk stratification framework exists to guide prophylaxis in this population. The Caprini score can effectively predict VTE risk in other surgical cohorts; however, its applicability to MSD patients remains uncertain. Therefore, this study assessed the performance of the Caprini score in predicting postoperative VTE among MSD patients. Methods A retrospective cohort study was conducted including adult MSD patients undergoing surgery from September 2017 to December 2024. Caprini scores were calculated using documented clinical characteristics. Postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) occurring within 90 days of surgery were identified through imaging reports and chart review. Comparative analyses evaluated the relationship between Caprini score and VTE outcomes, and receiver operating characteristic (ROC) analyses assessed predictive performance. Results A total of 336 patients were included. Overall VTE incidence was 8.0% (2.1% DVT, 6.5% PE). The cohort’s average Caprini score was 9.0±2.9, with 98% of patients categorized as high or highest risk. Caprini score was not significantly associated with DVT (p = 0.33), PE (p = 0.45), or overall VTE (p = 0.32) occurrence and demonstrated poor discriminatory ability for predicting VTE on ROC analysis (AUC 0.56, 95% CI [0.44, 0.58]). Using a threshold score of 10, Caprini score predicted VTE risk with a sensitivity of 44.4%, specificity of 66.3%, low positive predictive value (10.3%), and high negative predictive value (93.2%). VTE events occurred throughout the postoperative period, with a notable proportion diagnosed after discharge (∼50% of PEs and 72% of DVTs). Conclusions The Caprini score showed limited ability to stratify postoperative VTE risk in MSD patients, likely reflecting the uniformly elevated baseline risk within this population. Thus, improved predictive models incorporating disease-specific variables and biomarkers may be necessary to guide thromboprophylaxis strategies in this high-risk population.
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Yoo et al. (2026) conducted a cohort in Metastatic spine disease (MSD) requiring surgery (n=336). Caprini score was evaluated on Postoperative venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), occurring within 90 days of surgery (AUC 0.56, 95% CI 0.44-0.58, p=0.32). The Caprini score demonstrated poor discriminatory ability for predicting postoperative venous thromboembolism in patients with metastatic spine disease (AUC 0.56; 95% CI 0.44-0.58; p=0.32).
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