Impedance plethysmography for surveillance of deep venous thrombosis following early discharge of total joint replacement patients.

Abstract

Between April 1988 and February 1989, 877 patients undergoing total hip (394 patients) and total knee (483 patients) replacement surgeries were given warfarin prophylaxis perioperatively and were tested with impedance plethysmography (IPG) approximately 17 days postoperatively (10 days post-discharge) in the outpatient office. There were 69 positive IPG tests (7.8%). Further assessment of patients with positive IPG results using duplex scanning or venography confirmed DVT in 25 of the 69 patients (3.6%) in the popliteal or thigh areas, and ruled out venous disease in 44 patients. All 25 patients were readmitted for anticoagulation therapy with intravenous (IV) heparin and warfarin. There were no cases of pulmonary embolus. This study indicates that IPG testing is a safe and effective method of screening patients for DVT and its potentially fatal sequela of pulmonary embolus. Furthermore, IPG testing has proven to be cost effective, as it is a relatively simple procedure which can be administered by non-professional personnel in the outpatient office setting.