Hospital Variation and Patient Characteristics Associated With Vena Cava Filter Utilization

Abstract

Introduction There is wide variation in the use of vena cava filter (VCFs). Objectives This study assessed the hospital and patient characteristics associated with VCF use in deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods Inpatient discharge data from all acute care hospitals with DVT/PE during 2008–2014 in Kentucky were used. Hierarchical logistic regression models were used to evaluate the relationships of study variables with VCF use. Results During the study period, 81,922 discharges for DVT/PE were observed and 10.5% of these received a VCF. This included 12,083 cases of PE+DVT, 18,571 cases of PE only, and 51,268 cases of DVT only. VCF use among these groups was 22.7%, 6.0%, and 7.8%, respectively. In adjusted analyses, VCF use was associated with increasing age, indicating that those over age 65 were twice as likely to receive a filter compared to the reference (21–25 year-old) group. Significant comorbidities associated with VCF use included cancer, liver disease, cerebrovascular disease, atrial fibrillation, anemia, and concurrent bleeding. Lower extremity, proximal DVTs, and patients receiving thrombolytic therapy or embolectomy, those having surgery, and those who were unstable or had trauma, were also more likely to receive a filter. Among cancer types, brain and metastatic tumors were significantly associated with VCF use. Between-hospital variation after controlling for all covariates was 7.1%. Conclusion There was high variation in use of VCFs. Several high-risk subgroups were more likely to use VCFs including older adults and those with cancer and concurrent bleeding.

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

“…Given the continued growth in VCF use and the variation that has been observed between institutions,13, 14, 15, 16, 17 assessment of what factors drive retrieval rates and timing of anticoagulation on a national scale is needed to evaluate clinical practice 18. This study sought to evaluate the trend in retrieval rates and patient factors associated with retrieval as well as the association between retrieval and anticoagulation.…”

“…7,[9][10][11] Given these trends, the US Food and Drug Administration has issued a safety communication highlighting the need to remove VCFs once the risk of pulmonary embolism (PE) has subsided based on modeling studies showing that VCFs are most clinically beneficial if retrieved within 90 days after implantation. 11,12 Given the continued growth in VCF use and the variation that has been observed between institutions, [13][14][15][16][17] assessment of what factors drive retrieval rates and timing of anticoagulation on a national scale is needed to evaluate clinical practice. 18 This study sought to evaluate the trend in retrieval rates and patient factors associated with retrieval as well as the association between retrieval and anticoagulation.…”

Inferior Vena Cava Filters—Current Role and Controversies

“…11 This has led to a large variation in IVCF utilization in the past two decades, both internationally and even between different types of practices within the United States. 12 An international effort at web-based rIVCF registry in the post-FDA-warning period shows a decreased proportion of prophylactic insertions compared with those for classic indications, 24 and 40%, respectively. 13…”

“…It is important to make the patients and referring physicians understand that the data from the much popularized FDA MAUDE database is not an accurate estimate of true prevalence of complications, given that it only includes voluntary patient-reported events and does not take into account the denominator of total filter placements. [11][12][13][14][15][16][17] On the other hand, the overall body of data looking specifically at IVCF-related complications may be underestimating the true incidence, given the fact that most filter-related complications are asymptomatic 22 and routine imaging follow-up post-placement is not done is most practices.…”

Vena Cava Filter Retrieval Rates and Factors Associated With Retrieval in a Large U.S Cohort

“…7,[9][10][11] Given these trends, the US Food and Drug Administration has issued a safety communication highlighting the need to remove VCFs once the risk of pulmonary embolism (PE) has subsided based on modeling studies showing that VCFs are most clinically beneficial if retrieved within 90 days after implantation. 11,12 Given the continued growth in VCF use and the variation that has been observed between institutions, [13][14][15][16][17] assessment of what factors drive retrieval rates and timing of anticoagulation on a national scale is needed to evaluate clinical practice. 18 This study sought to evaluate the trend in retrieval rates and patient factors associated with retrieval as well as the association between retrieval and anticoagulation.…”