Background

Venous thromboembolism (VTE) is the leading preventable cause of mortality following bariatric surgery. Previous studies have investigated different risk calculators to predict VTE. However, there is no clear consensus, and few studies have described clinical application of these calculators. This is a retrospective cohort study of all patients undergoing primary sleeve gastrectomy (SG) at a high volume center between January 2020-December 2022. A standardized algorithm for extended chemoprophylaxis post-discharge based on the Caprini Score (Cap) was utilized. Three risk assessment calculatorsCap, Michigan Bariatric Surgery Collaborative Risk model (MBSCR) and the Cleveland Clinic Post-discharge Venous Thromboembolism after Bariatric Surgery (CC) were compared. Sensitivity, specificity, positive predictive value, negative predictive value, and provider compliance with recommended extended chemoprophylaxis were determined. A total of 660 patients underwent primary SG, of whom 3 developed a VTE (0.45%). The Cap and the CC calculators identified 1 of 3 of these patients as high risk (sensitivity 0.33) while the MBSCR did not identify any (sensitivity 0). Specificity of the MBSCR was highest at 0.93, followed by CC and Cap. Based on the risk models, 61.5% (Cap), 23.4% (CC) and 6.67% (MBSCR) patients required prolonged VTE prophylaxis following admission. Provider compliance with the risk algorithms varied from 56.1% (Cap), 91.3% (CC), and 79% (MBSCR). Our study demonstrated a low rate of VTE events following SG. Though all predictors had poor sensitivity and varying specificity, the CC calculator allows for the most optimal clinical application of extended chemoprophylaxis.