Relationship of inferior vena cava filter usage in post-surgical patients by various surgical and medical subspecialists.
Venous thromboembolism is a common and often fatal problem in postsurgical patients. These patients are usually treated with either therapeutic anticoagulation or the placement of inferior vena cava (IVC) filters. Controversy surrounds the use of IVC filters, because no data exist proving survival benefit. In this study, 264 inpatient medical records of patients who underwent major surgical procedures and had the diagnosis of deep venous thrombosis or pulmonary embolism were examined. Among these patients, those who received IVC filters were identified, and the documented indications for filter placement were reviewed. Rates of IVC filter placement per venous thromboembolism event and specific indications were examined across surgical subspecialties and by type of medical consultant. Sixty percent of patients received IVC filters. IVC filter placement rates varied significantly across surgical subspecialties (p <0.0001), with the highest rate in the orthopedic surgery subgroup (80%). Rates of IVC filter use also differed significantly (p <0.0007) between medical consultants who specialized in antithrombotic medicine (46.8%) and those who did not (68.3%). Significant differences also existed in specific indications for filter placement between medical and surgical subspecialties. In conclusion, most of this study's population received IVC filters. Rates of IVC filter placement varied by the specialties of surgeons and medical consultants. The heterogeneity of treatment strategies coupled with the lack of data for this patient population highlights the need for future prospective studies to guide evidence-based treatment.
Marmor
David B
DB
Division of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA. david.marmor@gmail.com
Merli
Geno J
GJ
Whellan
David J
DJ
Andrel
Jocelyn
J
Fisicaro
Tamara
T
Shamimi-Noori
Saum
S
Adams
Suzanne
S
Rubin
Alexander
A
Feldman
Arthur M
AM
D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012189:Retrospective Studies; D013038:Specialization; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000517:prevention & control*