Should Routine Screening Ultrasonography for Deep Vein Thrombosis be Used in Asymptomatic Patients During Hospitalization for Elective Spine Surgery? An Analysis and Review of 587 Consecutive PatientsDavid Kojo Hamilton, MD1, Akil Patel, MD1, Charles Sansur, MD11Baltimore, MD United States Keywords: thrombolysis, spine surgery, complications, Imaging, outcome
Deep Vein Thrombosis (DVT) is a well known complication of hospitalized neurosurgical patients. The value of screening ultrasonography for earlier detection of DVT in spine patients and the subsequent prevention of pulmonary complications remains unclear. This is especially true when evaluating DVT in asymptomatic patients undergoing spine surgery, who though non plegic or paretic, but due to pain and/or deconditioning, have not been very mobile preoperatively.
The goal of this study was to determine possible patterns, incidence and risk factors in acquiring DVT in asymptyomatic hospitalized spine surgery patients who underwent, routine on admission, and weekly, ultrasound screening for DVT.
A retrospective review of 587 consecutive adult spinal patients who underwent admission and weekly ultrasound screening at a university hospital center, over 1 year, was conducted.
All patients recieved standard mechanical and chemical prophylaxis. We reviewed patient demographics and high risk groups.
There was a 1.9% overall incidence of DVT in this population. Patients undergoing complex spinal surgery had a higher subgroup incidence with further pulmonary complications. Overall, 91% were diagnosed with a DVT within 7 days of hospital stay, 0% diagnosed within 8-14 days, and the rest were (9%) diagnosed after 14 days(p-value <0.05).
This is a retrospective study.
The effectiveness of routine ultrasonography screening for DVT may be most maximized if screening includes an initial admission and immediate post- op study in particularly high risk patients, followed by studies on only symptomatic patients.
D. Hamilton (), A. Patel (), C. Sansur ()