title: Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery.
abstract: BACKGROUND
  The United States Food and Drug Administration recently issued a warning about adverse events in patients receiving inferior vena cava (IVC) filters.
  
  
  OBJECTIVE
  To assess relationships between IVC filter insertion and complications while controlling for differences in baseline patient characteristics and medical venous thromboembolism prophylaxis.
  
  
  METHODS
  Propensity-matched cohort study.
  
  
  METHODS
  The prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative.
  
  
  METHODS
  Bariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012.
  
  
  METHODS
  Prophylactic IVC filter insertion.
  
  
  METHODS
  Outcomes included the occurrence of complications (pulmonary embolism, deep vein thrombosis, and overall combined rates of complications by severity) within 30 days of bariatric surgery.
  
  
  RESULTS
  There were no significant differences in baseline characteristics among the 1,077 patients with IVC filters and in 1,077 matched control patients. Patients receiving IVC filters had higher rates of pulmonary embolism (0.84% vs 0.46%; odds ratio [OR], 2.0; 95% confidence interval [CI], 0.6-6.5; P=0.232), deep vein thrombosis (1.2% vs 0.37%; OR, 3.3; 95% CI, 1.1-10.1; P=0.039), venous thromboembolism (1.9% vs 0.74%; OR, 2.7; 95% CI, 1.1-6.3, P=0.027), serious complications (5.8% vs 3.8%; OR, 1.6; 95% CI, 1.0-2.4; P=0.031), permanently disabling complications (1.2% vs 0.37%; OR, 4.3; 95% CI, 1.2-15.6; P=0.028), and death (0.7% vs 0.09%; OR, 7.0; 95% CI, 0.9-57.3; P=0.068). Of the 7 deaths among patients with IVC filters, 4 were attributable to pulmonary embolism and 2 to IVC thrombosis/occlusion.
  
  
  CONCLUSIONS
  We have identified no benefits and significant risks to the use of prophylactic IVC filters among bariatric surgery patients and believe that their use should be discouraged.
authors: Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. nbirkmey@umich.edu
authors: Nancy J
authors: NJ
authors: Birkmeyer
authors: Jonathan F
authors: JF
authors: Finks
authors: Wayne J
authors: WJ
authors: English
authors: Arthur M
authors: AM
authors: Carlin
authors: Abdelkader A
authors: AA
authors: Hawasli
authors: Jeffrey A
authors: JA
authors: Genaw
authors: Michael H
authors: MH
authors: Wood
authors: David A
authors: DA
authors: Share
authors: John D
authors: JD
authors: Birkmeyer
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects* / Q000295:instrumentation / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects* / Q000639:trends; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control