Association Between Inferior Vena Cava Filter Insertion in Trauma Patients and In-Hospital and Overall Mortality

Sarosiek, Shayna; Rybin, Denis; Weinberg, Janice; Burke, Peter; Kasotakis, George; Sloan, J. Mark

doi:10.1001/jamasurg.2016.3091

Cited by 45 publications

(32 citation statements)

References 28 publications

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“…The discrepancy between our findings and the 30–60% retrieval rates reported in single-center studies calls to question whether the more impressive results at specific institutions truly reflect overall practice patterns in the United States. Our findings corroborate those of a prior study with Medicare data which estimated a 1.2–5.1% retrieval rate 18 (Medicare patients in our cohort had a 2.5% retrieval rate) as well as a large single-center study of trauma patients where the retrieval rate was found to be 8% 20 (trauma patients had a 9.6% retrieval rate in our study). In addition, a recently published study reviewed state-wide filter placement and retrieval rates in New York and reported an overall retrieval rate of 3.5% between 2005 and 2014 21 .…”

Section: Discussionsupporting

confidence: 92%

Persistently low inferior vena cava filter retrieval rates in a population-based cohort

Mohapatra

Liang

Chaer

et al. 2019

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Background: Practice patterns associated with inferior vena cava (IVC) filter placement have seen considerable variation over the last decade. We utilized a state-wide administrative database to examine trends in IVC filter placement and retrieval in the general population. Methods: We reviewed Florida state inpatient and ambulatory surgery databases from 2004–2014. International Classification of Diseases-9 diagnosis and procedure codes and Current Procedural Terminology (CPT) codes were searched for patients undergoing inpatient or outpatient IVC filter placement, and each patient was longitudinally tracked to the time of inpatient or outpatient filter retrieval. For inpatient filter placements, associated diagnoses were reviewed to identify indications for placement. Univariate and multivariate logistic regression models were constructed to identify factors associated with improved retrieval rates. Results: 131,791 IVC filter placements were identified over the 11-year period, with a 50% increase from 2004–2010 and a 24% decline from 2010–2014. Median age at filter placement was 71 (interquartile range [IQR] 57–81). Mean follow-up after filter placement was 17.3 ± 25.5 months. Only 8,637 filters (6.6%) were retrieved. The annual retrieval rate trended upward, from 3.4% in 2004 to 8.5% in 2013 (P < .001). Median filter dwell time was 96.5 days (IQR 44–178). Diagnoses associated with filter placement included venous thromboembolism (75.9%), trauma (35.0%), hemorrhage (29.9%), malignancy (29.4%), and stroke (5.1%). Retrieval rates were highest in younger patients (34.0% in patients under 20) and lowest in Medicare patients (2.5%). In a multivariate logistic regression model, Medicare was associated with decreased retrieval rates (OR 0.33, 95% CI 0.31–0.35, P < .001) after adjusting for age and associated diagnoses. Weaker risk factors included increased age, white race, and diagnoses of deep vein thrombosis, pulmonary embolism, or malignancy. A trauma diagnosis was associated with improved retrieval. To further investigate the Medicare effect, a propensity score-matched model was created to better account for confounding effects. In this model, Medicare persisted as a risk factor for decreased filter retrieval (OR 0.43, 95% CI 0.40–0.46, P < .001). Conclusions: IVC filter placements, after a substantial increase between 2004 and 2010, have been declining since 2010. Retrieval rates in the general population are steadily improving but continue to lag those described in center-specific literature. Increased age and Medicare as the primary payer are the strongest risk factors for lack of filter retrieval. Widespread improvements on a national scale are needed to improve the appropriateness of filter placements and to enhance filter retrieval rates.

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Section: Discussionsupporting

confidence: 92%

Persistently low inferior vena cava filter retrieval rates in a population-based cohort

Mohapatra

Liang

Chaer

et al. 2019

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…Hemmila et al analyzed trauma quality collaborative data from 2010 to 2014 and found that prophylactic IVCF placement had no effect on reducing trauma patient mortality, but was associated with an increase in DVT events (OR: 1.83, 95% CI: 1.15 - 2.93, P = 0.01) [ 18 ]. Sarosiek et al performed a retrospective cohort study of patients who underwent IVCF placement at a level 1 trauma center and found no significant difference in survival in trauma patients with or without placement of an IVCF, whether in the presence or absence of venous thrombosis [ 19 ]. As such, they call for re-examination of IVCF use in this patient population [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sarosiek et al performed a retrospective cohort study of patients who underwent IVCF placement at a level 1 trauma center and found no significant difference in survival in trauma patients with or without placement of an IVCF, whether in the presence or absence of venous thrombosis [ 19 ]. As such, they call for re-examination of IVCF use in this patient population [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature

et al. 2018

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BackgroundThere is a wide variability in practice patterns on the use of inferior vena cava filters (IVCFs) among institutions, which is likely due to contrasting indication guidelines published by different professional societies. The aim of the present study is to report our healthcare system use of IVCF to: 1) determine practice patterns, 2) determine factors that may predict IVCF retrieval and 3) identify areas for improvement.MethodsA retrospective review of 180 consecutive IVCF placement performed between July 2014 and December 2015 was conducted.ResultsOne hundred nine (60.6%) IVCFs were placed for absolute indications, 27 (15.0%) for relative indications, 26 (14.4%) prophylactically and 18 (10.0%) for unknown indications. Average age was 59.3 years. Ninety-five had active cancer. Surgical and medical services requested filter placement in 112 (62.2%) and 68 (37.8%) patients, respectively. Thirteen (7.2%) patients had a hematology consult prior to IVCF placement. Documentation of the presence of an IVCF was present in 118/127 (92.9%) discharge summaries, and outlined instructions for filter retrieval post-discharge were present in 20/124 (16.1%) cases. Only 33 (25.0%) IVCF were retrieved at a median interval of 162 days (range: 4 - 1,053 days). None of the factors of interest was found to be significantly associated with IVCF retrieval.ConclusionA root cause analysis identified that the lack of a structured system for IVCF tracking resulted in poor IVCF retrieval rates. This study resulted in the development of a hospital-initiated multidisciplinary team to address these issues.

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“… 91 The placement of an IVC filter does not impact mortality regardless of whether a DVT is present or absent. 92 , 93 While consensus guidelines provide conflicting recommendations and most studies have been observational, among patients diagnosed with an acute proximal DVT or PE who cannot receive adequate therapeutic anticoagulation, an IVC filter should be considered to reduce the rate of recurrent PE without altering the mortality rate. 94 …”

Section: Algorithmmentioning

confidence: 99%

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

Ley

Brown

Moore³

et al. 2020

J Trauma Acute Care Surg

145

260

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Association Between Inferior Vena Cava Filter Insertion in Trauma Patients and In-Hospital and Overall Mortality

Cited by 45 publications

References 28 publications

Persistently low inferior vena cava filter retrieval rates in a population-based cohort

Persistently low inferior vena cava filter retrieval rates in a population-based cohort

Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

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