Surveillance Venous Duplex Ultrasound in the Neurosurgical Population: A Single-Center Quality Improvement Initiative.

ABSTRACT Background Venous thromboembolism (VTE) represents a significant source of morbidity and mortality in the inpatient population and is considered a leading preventable cause of death among inpatients. Neurosurgical inpatients are of particular interest given higher rates of immobility, steroid use, and potential consequences of post-operative hemorrhage. A consensus protocol for VTE screening in this population does not exist, and institutional protocols vary widely. Methods We carried out a retrospective review of lower-extremity venous duplex ultrasound (VDUS) usage at our institution and applied this information to the development of a neurosurgery department-wide protocol, taking into account high-risk patient risk factors and indications for VDUS ordering. We then implemented this protocol, which consisted of pre-operative screening of patients at high risk for VTE and limited post-operative surveillance, for a period of six months and compared VDUS usage and VTE occurrence. Results Pre-operative VDUS screening prior to nonemergent neurosurgical procedures in high risk patients with active cancer, inability to ambulate, or history of DVT identified proximal DVTs that were accordingly treated. Post-operative routine surveillance VDUS only diagnosed incidental isolated calf DVT for which there were no clinically relevant sequelae. Overall post-operative surveillance VDUS usage decreased significantly (66.9% vs 13.5%, p=0.001). Conclusions Our findings lend support to pre-operative screening in high-risk patients and suggest that routine post-operative surveillance in asymptomatic patients is unnecessary.