To assess whether preoperative screening using venous duplex scanning (VDS) of the bilateral lower extremities is useful for identifying patients at risk of developing postoperative venous thromboembolism (VTE).

Three hundred fifty-two consecutive referral patients at high or highest risk for postoperative VTE according to the guidelines of the American College of Chest Physicians were studied. After VDS, all patients received low-dose unfractionated heparin for postoperative thromboprophylaxis. Patients were then followed for 3 months after surgery for investigation of clinically significant VTE.

Three hundred thirty patients were finally enrolled. Of these, orthopedic surgery patients were most common (140 patients, 42.4%), followed by general surgery (104 patients, 31.5%) and gynecologic (42 patients, 12.7%) surgery patients. Preoperative VDS identified 66 (20.0%) patients with deep vein thrombosis (DVT). Twenty-three (7.0%) patients had proximal DVT and the remaining 43 (13.0%) had distal DVT. Postoperative symptomatic VTE was found in 26 (7.9%) patients who had no evidence of preoperative DVT. Twenty-two patients developed calf DVT, two developed proximal DVT and two developed pulmonary embolism. In contrast, no propagation of DVT or new thrombus formation was found after surgery in patients who had preoperative DVT. Multivariate analysis showed that an age of >75 years (OR 2.57, 95% CI 1.14-5.82, p = 0.023) was the only significant predictor of postoperative VTE.

Preoperative screening does not identify patients at risk of developing clinically significant thromboembolic events.