Study Of Caprini Risk Assessment Model In The Risk Assessment Of Thrombosis After Hip Fracture Surgery

ObjectiveTo evaluate the early prediction value of Caprini risk assessment model combined with reclassification of risk classes and Fibrinogen(FIB)and Ddimer(D-dimer)3 days after surgery in patients with hip fracture complicated with DVT,and guide clinical treatment.MethodA retrospective case-control study design was used to continuously collect patients admitted to the orthopedic ward of our hospital from January2020 to June 2022 who were diagnosed with femoral neck fracture or intertrochanteric fracture and underwent internal fixation or hip replacement.57 patients diagnosed with lower limb DVT by ultrasound Doppler after surgery were selected as the case group.A total of 114 nonDVT patients admitted during the same period were randomly selected as the control group.Among them,112 were female and 59 were male,ranging in age from 43 to 97.Statistical data of the subjects were collected,including gender,age,Body Mass Index(BMI),FIB and D-D measurements before and 3 days after surgery,and the incidence of underlying diseases(hypertension,coronary heart disease,diabetes),etc.Color Doppler venous ultrasonography was used to confirm perioperative DVT.Caprini risk stratification was performed again according to the incidence of thrombus,and the optimal risk classification of postoperative DVT was determined by Caprini score.The clinical prediction efficiency of Caprini risk assessment model after hip fracture surgery was evaluated by Receiver Operating Curve(ROC).ResultsThe risk of postoperative DVT in highly high-risk(≥14 points)patients is 20.541 times higher than that in moderate-risk(8-10 points)patients(P<0.05).The Area Under the ROC(AUC)of the postoperative Caprini score predicting the occurrence of DVT after hip fracture was 0.749(P< 0.05),and the optimal critical value was 13.5 points.The FIB(6.05±1.51 vs 4.37±1.26)and D-D(7.23±1.66 vs 4.92±1.49)of thrombus group 3 days after surgery were significantly different from those before surgery(P < 0.05).The blood FIB(4.13±1.10 vs 4.10±1.19)and D-D(4.89±1.35 vs 4.72±1.26)of control group 3 days after surgery.There was no significant difference between the two groups before operation(P > 0.05).There were significant differences in FIB(6.05±1.51 vs 4.13±1.10)and D-D(7.23±1.66 vs 4.89±1.35)between the two groups at 3 days after surgery(P < 0.05).Based on the results of multivariate analysis,the ROC curves of independent risk factors for DVT in patients with hip fracture and some factors with potential predictive value of DVT were plotted.The results showed that the D-D values at 3 days after surgery had the highest potential value,with AUC=0.860,sensitivity 70.2% and specificity 89.5%.The AUC of FIB measured 3 days after operation was 0.846,sensitivity 70.2%,specificity 83.3%.The Caprini score AUC is 0.749,the sensitivity is 70.2%,and the specificity is 67.5%.The D-D measurements,FIB measurements and Caprini scores 3 days after surgery were incorporated to construct the ROC curves of multiple measurement indicators.The results show that AUC = 0.930,95%CI is 0.884-0.977,P<0.001Conclusion:1.Reclassification of Caprini risk stratification after surgery can effectively predict the risk of postoperative DVT in patients with hip fracture,which can guide clinical treatment.2.Postoperative changes in D-D and FIB measurements can be of high value in early diagnosis of DVT.3.Caprini scores combined with postoperative D-D and FIB measurements have predictive value for DVT risk assessment of patients after hip fracture surgery.