Improved Removal Rates for Retrievable Inferior Vena Cava Filters with the Use of a ‘Filter Registry’

Abstract

The American Association for the Surgery of Trauma challenged the trauma community to improve a 22 per cent average removal rate for retrievable inferior vena cava filters (r-IVCFs). Since 2006, we maintained a “filter registry” documenting all IVCFs placed in trauma patients. Our goal was to improve removal rates for r-IVCF. Patients receiving an IVCF before implementation of filter registry, 2003–2005, comprised the control group. Patients receiving an IVCF after implementation of filter registry, 2006–2009, comprised the study group. Data obtained included age, gender, Injury Severity Score (ISS), length of stay (LOS), mortality, filter inserted, placement indication, removal rates, and reasons why removal did not occur. Fisher exact test and chi square were used for nominal variables. Stepwise logistic regression analysis was used to define predictors of removing and not removing an IVCF. Three hundred seven patients received an IVCF, 142 preregistry and 165 post-registry. No significant difference existed between groups in age, gender, ISS, placement indication, or mortality. A significant difference existed between groups in LOS and presence of deep vein thrombosis (DVT) and pulmonary embolism. A total of 98.2 per cent of postregistry patients received a Günther Tulip filter and all retrievals were performed by Interventional Radiology. Retrieval rates improved, 15.5 to 31.5 per cent post registry ( P < 0.001). No differences existed in lost to follow-up (LTF) between groups. Univariate analysis identified age, IVC clot, DVT, and LTF as predictors for not removing a filter. Stepwise logistic regression revealed the filter registry independently predicts the removal of an r-IVCF. A filter registry is effective in improving rates of removal for r-IVCFs.

Current Status of the Retrieval Rate of Retrievable Vena Cava Filters in a Tertiary Referral Center in Korea

“…Meisner et al [ 8 ] have shown an increased retrieval rate after establishment of an IVCF clinic. Kalina et al [ 9 ] have reported that application of a filter registry can significantly increase the retrieval rate. Irwin et al [ 10 ] have suggested constructing a prospective data-collecting system for patient follow-up.…”

Factors impacting follow-up care after placement of temporary inferior vena cava filters

“…In their study, both attempts to retrieve an IVC filter and the aggregate rates for IVC filter retrieval were nearly doubled from 15.5% preregistry to 31.5% after registry implementation. 8 Interestingly, we observed that the distance between a patient's usual residence and the hospital did not significantly impact follow-up rates. Similarly, patients who were admitted to our institution following a traumatic injury did not have a significant difference in follow-up rates compared with patients with other admission diagnoses.…”

“…11 Various reports have demonstrated a significant reduction of symptomatic acute PE in patients who receive an IVC filter following a diagnosis of an acute DVT, 12 and over the past decade, there has been a dramatic increase in the number of IVC filters implanted per year. 2 This increase is multifactorial and is likely associated with a rise in efforts to diagnose symptomatic VTE, an increase in the variety and efficacy of currently available IVC filters, an increase in the ease of insertion of 2,8,9,13 In the study herein, we demonstrate that implementation of a follow-up protocol for patients who receive an IVC filter is feasible. We also confirm that for patients who do not have their IVC filter removed, outpatient follow-up is the main obstacle to filter retrieval.…”

“…7 Some have suggested that suboptimal retrieval rates are due to poor clinical outpatient follow-up. 8 Lucas and colleagues demonstrate that enrollment of trauma patients who received an IVC filter into a tracking registry significantly improved follow-up and doubled resultant IVC filter retrievals. 9 In an effort to improve our institution's IVC filter retrieval rates, in May 2009 we implemented a follow-up protocol for patients who received an IVC filter.…”

Institutional protocols can improve IVC filter retrieval rates

“…For example, Christiana Care Health System, a network hospital system that serves several states in the Northeastern United States, doubled its retrieval rate by simply creating and maintaining an IVC filter registry. 5 A hospital in New Zealand found that they were able to achieve a 100% 12-month rate of filter retrieval by implementing a review of individual cases by a venous thromboembolism specialist as well as maintaining a vena caval filter database. 2 North Memorial Medical Center in Minnesota also chose to review individual cases.…”