Vena Cava Filter Retrieval Rates and Factors Associated With Retrieval in a Large US Cohort

Brown, Joshua D.; Raissi, Driss; Han, Qin; Adams, Val R.; Talbert, Jeffery

doi:10.1161/jaha.117.006708

Cited by 56 publications

(42 citation statements)

References 42 publications

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“…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 . Our retrieval rates are notably lower than those reported by Brown et al, who utilized a national private insurance claims database and estimated an overall retrieval rate of 18.4% 22 . The lower age, lower proportion of Medicare patients, and ability to account for mortality as a competing risk all likely contributed to a higher estimate of retrieval rates by these investigators compared to our study; however, despite all these factors, the authors still found a lower retrieval rate than would be expected based on single-center data.…”

Section: Discussioncontrasting

confidence: 89%

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: Discussioncontrasting

confidence: 89%

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

View full text Add to dashboard Cite

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“…It is widely reported that the rate of removal of retrievable IVC filters is suboptimal (41). There are also limited safety data on the long-term outcomes of filters designed with retrieval or conversion capabilities.…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease

Kaufman

Barnes

Chaer

et al. 2020

Journal of Vascular and Interventional Radiology

135

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“…An additional marker of quality of care for IVCF patients would include retrieval for non-permanent devices between hospitals as retrieval rates have been reported to be only 10-40%. 18,[31][32][33] However, retrieval is often done on an outpatient basis and would not be observable in inpatient discharge data.…”

Section: Limitationsmentioning

confidence: 99%

Hospitalization metrics associated with hospital-level variation in inferior vena cava filter utilization for patients with venous thromboembolism in the United States: Implications for quality of care

et al. 2018

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Variation in the use of inferior vena cava filters (IVCFs) across hospitals has been observed, suggesting differences in quality of care. Hospitalization metrics associated with venous thromboembolism (VTE) patients have not been compared based on IVCF utilization rates using a national sample. We conducted a descriptive retrospective study using the Nationwide Readmissions Database (NRD) to delineate the variability of hospitalization metrics across the hospital quartiles of IVCF utilization for VTE patients. The NRD included all-payer administrative inpatient records drawn from 22 states. Adult (≥ 18 years) patients with VTE hospitalizations with or without IVCF were identified from January 1, 2013 through December 31, 2014 and hospitals were divided into quartiles based on the IVCF utilization rate as a proportion of VTE patients. Primary outcome measures were observed rates of in-hospital mortality, 30-day all-cause readmissions and VTE-related readmissions, cost, and length of stay. Patient case-mix characteristics and hospital-level factors by hospital quartiles of IVCF utilization rates, were compared. Overall, 12.29% of VTE patients had IVCF placement, with IVCF utilization ranging from 0% to 46.84%. The highest quartile had fewer pulmonary embolism patients relative to deep vein thrombosis patients, and older patient ages were present in higher quartiles. The highest quartile of hospitals placing IVCFs were more often private, for-profit, and non-teaching. Patient and hospital characteristics and hospitalization metrics varied by IVCF utilization rates, but hospitalization outcomes for non-IVCF patients varied most between quartiles. Future work investigating the implications of IVCF utilization rates as a measure of quality of care for VTE patients is needed.

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Vena Cava Filter Retrieval Rates and Factors Associated With Retrieval in a Large US Cohort

Cited by 56 publications

References 42 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

Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease

Hospitalization metrics associated with hospital-level variation in inferior vena cava filter utilization for patients with venous thromboembolism in the United States: Implications for quality of care

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