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Related Experiment Videos

Is duplex venous surveillance worthwhile after arthroplasty?

T E Brothers1, C E Frank, B Frank

  • 1Ralph Henry Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA.

The Journal of Surgical Research
|January 1, 1997
PubMed
Summary
This summary is machine-generated.

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Routine screening for deep venous thrombosis (DVT) after joint replacement surgery is not cost-effective. The low incidence of DVT with current prophylaxis means aggressive screening programs are not justified.

Area of Science:

  • Orthopedic Surgery
  • Vascular Medicine
  • Health Economics

Background:

  • Deep venous thrombosis (DVT) is a known complication of hip and knee arthroplasty.
  • Prophylactic therapy significantly reduces DVT incidence.
  • The effectiveness of routine postoperative surveillance for DVT detection in patients receiving prophylaxis is uncertain.

Purpose of the Study:

  • To evaluate the efficacy and cost-effectiveness of routine postoperative duplex ultrasound surveillance for detecting DVT after hip or knee arthroplasty in patients receiving prophylactic therapy.

Main Methods:

  • Decision analysis was used to assess surveillance duplex exams from 738 hip or knee arthroplasty patients.
  • Patients were stratified into symptomatic and asymptomatic groups.
  • Cost-effectiveness was calculated using 1995 Medicare reimbursement rates.

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Main Results:

  • The overall DVT incidence was 1.4% (10/738) with no reported pulmonary emboli.
  • In asymptomatic patients, only 0.5% of surveillance duplex scans detected DVT.
  • Screening yielded an incremental cost of $35,000 per additional DVT detected.

Conclusions:

  • The low incidence of DVT and pulmonary emboli in patients undergoing arthroplasty with current prophylaxis does not support routine screening.
  • Aggressive screening programs for DVT are not cost-effective.
  • A higher incidence of DVT would be required for screening to be considered worthwhile.