Assessment of the risk of Venous thromboembolism( VTE) after Laparoscopic surgery according to caprini Score guidelines.

Design: Prospective nonrandomised control trial

Setting: Tertiary care multispecialty Hospital

Introduction:

Laparoscopic procedures have rapidly become most performed method throughout world. Laparoscopic procedure provides shorter hospital stay, early recovery, reduced wound infection rate and reduce post operative complications.VTE is a major cause of morbidity and mortality in patients undergoing gastrointestinal surgery. The incidence of fatal PE ranges from 0.1% to 0.8% in patients undergoing elective general surgical procedures ( 1 ). Despite wide acceptance of laparoscopic procedures for many general surgeries cases, the incidence of VTE is not well defined. We outline the prophylaxis strategies based on the calculated risk for VTE.As per Caprini guidelines score.

Patients and methods:

Patients intended to undergoing laparoscopic procedure were prospectively enrolled between march 2015 to march 2016.The laparoscopic procedure were cholecystectomy,Appendicectomy ,ventral hernia repair, Lap assisted vaginal hysterectomy(LAVH) or combined surgery. Patients demography, procedure details, time, any co morbid illness  andcaprini score for venous thromboembolism(VTE) were recorded. Also grading of risk for VTE was recorded.

Results:

Eighty patients were enrolled for the study.In this study n=57 were for laparoscopiccholecystectomy,n=11 for appendicectomy,n=4 for ventral hernia repair,n=3 for LAVH,and n=5 were for combined. There was no statistically significant difference for age,sex,height and weight. Themean duration of surgery was 117.27±28.31,142±45,126.60±28.86,and 164±26 respectively.We assessed the risk of VTE for all eighty patients using caprini score and level the risk according to total risk factor score.We found that the level of risk as per caprini score were between moderate to high( n=20,n=56 respectively) and n=4 as highest.

Conclusion:

Laparoscopic surgeries may have an increased risk for development of VTE, due to abdominal pressure, reverse trendelberg position as well as prolonged surgery time. Patients with comorbid illness like varicose veins, h/o thromboembolism, may increase the risks of development of thromembolic complications. Assessment of risk postoperatively and recommendations of VTE prophylaxis is considered in moderate to highest group.