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Caprini assessment utilization and impact on patient safety in gynecologic surgery

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Postoperative venous thromboembolism (VTE) can potentially be associated with significant morbidity, mortality, and healthcare costs. The aim of this study was to determine the utilization of Caprini guideline indicated VTE in elective gynecologic surgery patients and its impact on postoperative VTE and bleeding complications.


This was a retrospective cohort study of elective gynecologic surgical procedures performed between January 1, 2016, and May 31, 2021. Two study cohorts were generated: (1) those who received and (2) those who did not receive VTE prophylaxis based on Caprini score risk stratification. Outcome measures were then compared between the study cohorts and included the development of a VTE up to 90-days postoperatively. Secondary outcome measures included postoperative bleeding events.


A total of 5471 patients met inclusion criteria and the incidence of VTE up to 90 days postoperatively was 1.04%. Overall, 29.6% of gynecologic surgery patients received Caprini score-based guideline VTE prophylaxis. 39.2% of patients that met high-risk VTE criteria (Caprini > 5) received appropriate Caprini score-based prophylaxis. In multivariate regression analysis, the American Society of Anesthesiologists (ASA) score (OR 2.37, CI 1.27–4.45, p < 0.0001) and Caprini score (OR 1.13, CI 1.03–1.24, p = 0.008) predicted postoperatively VTE occurrence. Increasing Charlson comorbidity score (OR 1.39, CI 1.31–1.47, P < 0.001) ASA score (OR 1.36, CI 1.19–1.55, P < 0.001) and Caprini score (OR 1.10, CI 1.08–1.13, P < 0.001) were associated with increased odds of receiving appropriate inpatient VTE prophylaxis.


While the overall incidence of VTE was low in this cohort, enhanced adherence to risk-based practice guidelines may provide more patient benefit than harm to postoperative gynecologic patients.

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Data availability

All additional data set and analysis related to tis study are available upon request. Further inquiries can be directed to the corresponding author.


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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations



GL: preparing original manuscript draft, manuscript revisions, and preparing drafts of result tables and figures. AS: statistical analysis and preparation of methodology. EB: data acquisition from the electronic health records and generation of result outputs. TD: critical review of original and revised manuscript drafts. JB: critical review of original and revised manuscript drafts. DC primary collaborator on the project and provided critical review of original and revised manuscript drafts. JC: critical review of original and revised manuscript drafts. ME: study conceptualization, data validation, manuscript outline, creation of final result tables, critical review and editing of multiple manuscript drafts and approval of final submitted manuscript.

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Correspondence to Gregory K. Lewis or Michael A. Edwards.

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Conflicts of interest

All authors involved in this study declare that they have no conflicts of interest. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Mayo Clinic Institutional Review Board approved this study. This article does not contain any studies with animals performed by any of the authors.

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Lewis, G.K., Spaulding, A.C., Brennan, E. et al. Caprini assessment utilization and impact on patient safety in gynecologic surgery. Arch Gynecol Obstet 308, 901–912 (2023).

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