title: Technical and financial feasibility of an inferior vena cava filter retrieval program at a level one trauma center.
abstract: BACKGROUND
  Considering new guidelines for retrievable inferior vena cava filters (IVCFs), we examine our initial experience after establishing a comprehensive filter removal program in our level 1 trauma center. We evaluated the technical and financial feasibility of this program and barriers to IVCF retrieval, including insurance status and costs, in trauma patients.
  
  
  METHODS
  Trauma patients receiving IVCFs from May 2011 to 2013 were consented and prospectively enrolled in the study program. Retrieval rates were assessed for the years before study initiation. Primary outcome was IVCF retrieval. Hospital financial data for retrieval were examined and univariate analysis performed. Hospital cost-to-charge and payment-to-charge ratios were assessed.
  
  
  RESULTS
  Before study initiation from April 2009 to 2011, 66 IVCFs were placed in trauma patients with only 2 retrievals in 2 years. During the study period, 247 trauma patients had IVCF placement of which 111 (45%) were enrolled. The main reason for nonenrollment was lack of referral by the implanting team. Retrieval was attempted in 100 outpatients with success in 85 (85%). Patients enrolled in the program were more likely to have their filters removed (73% vs. 18%; odds ratio, 12.6; 95% confidence interval, 6.6-24.3; P < 0.001). Mean time from placement to attempt was 6.2 ± 4.0 months (range, 0.5-31.8). Of the total attempts, 29% were nonresource patients, 11% had Medicaid, and 60% had commercial insurance including Medicare patients. Chances of successful retrieval were higher if performed later during the study (P = 0.03). Successful retrieval was not related to insurance status (P = not significant). The mean total hospital charges related to retrieval were $4,493 (range, $2,510-$9,106). Successful retrieval contributed to lower total charges (P < 0.01). Factors contributing to higher total charges were retrieval attempt later in study period (P = 0.01) and commercial insurance status (P = 0.04).
  
  
  CONCLUSIONS
  The rate of IVCF placement in trauma patients increased 4-fold over 4 years. The rate of IVCF retrieval increased more than 14-fold during the same period after establishment of the retrieval program. Elective outpatient retrieval of IVCFs in all eligible trauma patients is financially feasible without loss to the health care system even in regions with high rates of uninsured. A major barrier to successful filter retrieval was lack of patient referral into the program by implanting physicians. Hospital administration and physician outreach are important determinants of successful IVCF retrieval in trauma patients.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Memorial Hermann Hospital, Texas Medical Center, Houston, TX. Electronic address: Kristofer.CharltonOuw@uth.tmc.edu.
authors.forename: Kristofer M
authors.initials: KM
authors.lastname: Charlton-Ouw
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Leake
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Cristina N
authors.initials: CN
authors.lastname: Sola
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Harleen K
authors.initials: HK
authors.lastname: Sandhu
authors.affiliation: Memorial Hermann Hospital, Texas Medical Center, Houston, TX; Division of Acute Care Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Rondel
authors.initials: R
authors.lastname: Albarado
authors.affiliation: Memorial Hermann Hospital, Texas Medical Center, Houston, TX; Division of Acute Care Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Memorial Hermann Hospital, Texas Medical Center, Houston, TX.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Memorial Hermann Hospital, Texas Medical Center, Houston, TX.
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Memorial Hermann Hospital, Texas Medical Center, Houston, TX.
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
mesh_terms: D000328:Adult; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000009:adverse effects / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D016017:Odds Ratio; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000191:economics*; D016896:Treatment Outcome; D014481:United States; D016306:Vena Cava Filters / Q000009:adverse effects / Q000191:economics*; D054556:Venous Thromboembolism / Q000191:economics / Q000517:prevention & control*; D055815:Young Adult