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Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients

Hemmila, Mark R. MD*; Osborne, Nicholas H. MD*; Henke, Peter K. MD*; Kepros, John P. MD; Patel, Sujal G. MD; Cain-Nielsen, Anne H. MS*; Birkmeyer, Nancy J. PhD*

doi: 10.1097/SLA.0000000000001434
ASA Papers

Objective: Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and VTE.

Summary Background Data: The prevalence of prophylactic placement of IVC filters has increased among trauma patients. However, there exists little data on the overall efficacy of prophylactic IVC filters with regard to outcomes.

Methods: Trauma quality collaborative data from 2010 to 2014 were analyzed. Patients were excluded with no signs of life, Injury Severity Score <9, hospitalization <3 days, or who received IVC filter after occurrence of VTE event. Risk-adjusted rates of IVC filter placement were calculated and hospitals placed into quartiles of IVC filter use. Mortality rates by quartile were compared. We also determined the association of deep venous thrombosis (DVT) with the presence of an IVC filter, accounting for type and timing of initiation of pharmacological VTE prophylaxis.

Results: A prophylactic IVC filter was placed in 803 (2%) of 39,456 patients. Hospitals exhibited significant variability (0.6% to 9.6%) in adjusted rates of IVC filter utilization. Rates of IVC placement within quartiles were 0.7%, 1.3%, 2.1%, and 4.6%, respectively. IVC filter use quartiles showed no variation in mortality. Adjusting for pharmacological VTE prophylaxis and patient factors, prophylactic IVC filter placement was associated with an increased incidence of DVT (OR = 1.83; 95% CI, 1.15–2.93, P-value = 0.01).

Conclusions: High rates of prophylactic IVC filter placement have no effect on reducing trauma patient mortality and are associated with an increase in DVT events.

*Department of Surgery, University of Michigan, Ann Arbor, MI

Department of Surgery, Michigan State University College of Human Medicine, Lansing, MI

Department of Surgery, Covenant Healthcare, Saginaw, MI.

Reprints: Mark R. Hemmila, MD, Trauma Burn Center, University of Michigan Health System, 1B407 University Hospital, 1500 E Medical Center Drive, SPC 5033, Ann Arbor, MI 48109-5033. E-mail: mhemmila@umich.edu.

Presented at the American Surgical Association Meeting, San Diego, CA, April 23–26, 2015.

Disclosure: Mark R. Hemmila and Nancy J. Birkmeyer were supported by Blue Cross Blue Shield of Michigan (BCBSM) Collaborative Quality Initiatives program grants. Nancy J. Birkmeyer was supported by AHRQ grant R01-HS018728.

Mark R. Hemmila, Anne H. Cain-Nielsen, Nancy J. Birkmeyer: Salary Support from Blue Cross Blue Shield of Michigan and Blue Care Network for MTQIP.

Peter K. Henke: Salary Support from Blue Cross Blue Shield of Michigan and Blue Care Network for Blue Cross Blue Shield of Michigan Vascular Interventions Collaborative (BMC2-PVI). Nancy J. Birkmeyer: Spouse of John D. Birkmeyer, MD a founder and equity partner in ArborMetrix Corporation. MTQIP contracts with ArborMetrix for web-based outcomes reporting.

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