ArticlePatient safety in surgery2026
The role of early venous duplex screening in improving patient safety indicator-12 (PSI-12) classification accuracy: a retrospective cohort study.
Article in Patient safety in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundVenous thromboembolism (VTE) is a major cause of morbidity among surgical patients. Patient Safety Indicator 12 (PSI-12) identifies perioperative VTE events. This study evaluates whether early admission duplex ultrasound identifies VTEs associated with PSI-12 coding and assesses PSI-12 classification accuracy.
methodsA single-center retrospective analysis was conducted on surgical patients with a venous duplex ultrasound within 48 h of admission at a large academic medical center (2013-2024). Two cohorts were analyzed: (1) all surgical patients with early duplex imaging, (2) PSI-12 positive elective surgical patients with early duplex imaging. The primary outcome was the prevalence of pre-existing DVT identified within 48 h among PSI-12 positive patients. Diagnostic accuracy of early abnormal duplex findings for predicting PSI-12 classification was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
resultsAmong all 10,498 surgical patients, 10.6% had positive duplex findings for DVT. PSI-12 positive patients had double the prevalence compared to PSI-12 negatives (20.9% vs. 10.4%, p < 0.001). In PSI-12 positive elective cases, 10.7% of preoperative duplex studies identified a DVT. Misclassification, defined as PSI-12 positive admissions without imaging-confirmed DVT or pulmonary embolism, occurred in 8.7% of elective cases. Overall, 36.7% of PSI-12 positive patients had abnormal early duplex findings. Early duplex demonstrated limited sensitivity but high specificity (sensitivity 36.7%, specificity 81.7%, PPV 3.7%, NPV 98.5%).
conclusionsOur findings suggest possible pre-existing disease rather than hospital-acquired VTE in PSI-12 positive patients. Incorporating admission duplex studies could improve PSI-12 classification accuracy, reduce costs, and enhance patient safety.
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