Sequential screening to predict XXXX after gynecologic surgery in Nara, Japan.

@entity1 @entity1150 @entity1151
OBJECTIVE: To evaluate a sequential screening method's efficacy in predicting @entity1151 (PTE) after gynecologic surgery. METHODS: A prospective study employing a two-stage screening process was conducted among consecutive asymptomatic adults who underwent outpatient evaluation for gynecologic surgery at Nara Medical University Hospital, Japan, between April 1, 2004, and December 31, 2013. @entity1 with a preoperative plasma D-dimer level greater than or equal to 1.0 g/mL underwent compression ultrasonography of the lower extremities. The primary outcome measure was postoperative detection of symptomatic PTE. RESULTS: Overall, 1729 @entity1 were included. The mean D-dimer level was 1.7  3.3 g/mL. Compression ultrasonography was conducted among 470 (27.1%) @entity1 with positive D-dimer test results; symptomatic @entity1150 ( @entity1150 ) was preoperatively detected among 94 (20.0%) of them. @entity1 with @entity1150 (n=94) had higher D-dimer levels than @entity1 (n=1635) without (7.8  12.8 g/mL vs 1.1  1.8 g/mL; P<0.001). Despite anticoagulant therapy, symptomatic PTE was detected postoperatively among two of these 94 @entity1 . Symptomatic PTE was also detected among four of 376 @entity1 with positive D-dimer test results but no evidence of @entity1150 by ultrasonography. No clinical onset of postoperative PTE was observed among 1259 @entity1 with D-dimer levels below the cut-off value. CONCLUSION: The PROVEN screening strategy (Preoperative surveillance using a sequential strategy) was ineffective at predicting postoperative symptomatic PTE.
