Comparative analysis of different modifications of the Caprini risk score in bariatric surgery

Background Bariatric surgery is associated with an increased risk of postoperative venous thromboembolism (VTE). This study aimed to compare the predictive accuracy of the Caprini risk score (CRS 2005, 2010, and a population-specific version) for postoperative VTE in obese patients undergoing bariatric surgery. Methods A prospective observational study was conducted from 2020 to 2025, involving 120 patients aged 26–75 years with obesity (BMI, 35-85 kg/m 2 ) undergoing laparoscopic bariatric surgery. VTE risk factors were assessed, including visceral fat area by computed tomography, estimated fat apron weight (FAW), severe obstructive sleep apnea (sOSA), CO 2 -pneumoperitoneum pressure, and popliteal vein blood flow measured intraoperatively via Doppler ultrasound scan. The primary outcome combined asymptomatic and symptomatic deep vein thrombosis (DVT) and symptomatic pulmonary embolism (PE) within 30 days postoperatively. Results The incidence of postoperative VTE was 5.0% (95% CI, 2.3–10.5%), including one symptomatic PE (0.8%). Regression analysis identified CRS 2010, the estimated FAW, and sOSA as significant predictors of VTE. In the modified CRS, a FAW ≥11 kg was assigned 1 point, and the presence of sOSA was assigned 3 points. The improved predictive accuracy was observed with the CRS 2010, considering sOSA (AUC, 0.866; 95% CI, 0.794–0.939) and sOSA with FAW (AUC, 0.862; 95% CI, 0.784–0.939). The optimal cut-off value was ≥12 points (sensitivity 83%, specificity 81%). Conclusions In bariatric surgery, CRS 2010 with sOSA and FAW showed a potential improvement in predicting postoperative VTE, with scores ≥12 indicating the highest risk. Although these findings remain preliminary and require further validation.