Routine Preoperative Venous DoppBler Screening is Not Effective in Preventing Thromboembolic Events after Total Joint Arthroplasty

Background: Despite advances in thromboprophylaxis, the relationship between preexisting DVTs and postoperative thromboembolic complications is not fully established. The aim of this study was to assess the utility of selective and non-selective preoperative lower extremity venous dopplers screening protocols as tools in reducing the incidence of postoperative thromboembolic events (DVT/PE) after total joint arthroplasty (TJA).

Methods: In a 2-year period between August 2013 and August 2015, 457 consecutive primary elective TJAs were identified form our prospective IRB approved database. During the first year, a selective preoperative screening ultrasound doppler protocol (only patients with a history of DVT/PE) was utilized in 184 patients, 31 of which had preoperative ultrasounds. The following year, a non-selective screening protocol was utilized in 273 consecutive patients, all of whom had a preoperative ultrasound doppler. All patients were followed for a minimum of 3 months postoperatively for post-operative dopplers, emergency room (ER) visits or re-admissions related to DVT/PE.

Results: Preoperatively, there was no difference between the selective and nonselective cohorts with respect to preoperative DVTs (3 and 1, respectively; p=0.307), all were known to have prior DVT. Postoperative thromboembolic events were found in 4 (2.6%) patients in the selective cohort and 2 (0.7%) patients in the non-selective cohort (p=0.196).

Conclusions: Utilization of a non-selective pre-operative ultrasound doppler protocol did not improve the identification of preoperative DVTs, or reduce postoperative thromboembolic complications.