Utility of Activity Measure for Postacute Care Scoring in Predicting Symptomatic Deep Venous Thromboembolism in Free Tissue Transfer

Abstract

Background: Free tissue transfer (FTT) can be associated with limited postoperative mobility, increasing the risk for venous thromboembolism (VTE). Currently, no standardized protocol for anticoagulation in FTT exists. VTE risk has been calculated using the Caprini score, which is based on preoperative assessments and lacks real-time data on postoperative mobility. The Activity Measure for Postacute Care (AM-PAC) score assesses patients' activity limitations and rehabilitation needs postoperatively. We hypothesize that AM-PAC score will correlate with postoperative VTE in FTT patients and may be a useful adjunct to the Caprini score in anticoagulation decision-making.

Methods: A review was completed of patients undergoing FTT for breast or lower extremity reconstruction at a single institution from 2012 to 2023. Data were collected on patient demographics, donor and recipient site, AM-PAC score, Caprini score, postoperative VTE, and medical comorbidities. A composite score was calculated using equally weighted AM-PAC and Caprini scores. Data were analyzed using Wilcox rank-sum tests with a significance level of 0.05.

Results: There were 78 patients who underwent breast or lower extremity FTT with an inpatient AM-PAC score evaluation. Six patients developed VTE postoperatively. There was no significant association between VTE and Caprini or AM-PAC scores, but patients with VTE had significantly higher composite scores (P = 0.033), with a higher odds ratio than Caprini or AM-PAC scores.

Conclusions: Patients with VTE had significantly higher composite scores than patients without VTE. This may support utilizing AM-PAC score as an adjunct to Caprini score to guide postoperative anticoagulation.

Keywords: AM-PAC; Caprini; DVT; PE; VTE; free tissue transfer; mobility scoring.