title: Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis.
abstract: Background: Pulmonary embolism(PE)accounts for almost 40% of perioperative deaths after bariatric surgery.Placement of prophylactic inferior vena cava(IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate post- operative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28,2013.Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis(DVT),pulmonary embolism (PE),and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity,and Sidik- Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks(RR) and 95% Confidence Intervals(CI). Results: Seven observational studies were identified (n=102,767), with weighted average inci- dences of DVT(0.9%),PE(1.6%),and mortality(1.0%)for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR2.81,95%CI 1.33-5.97, p=0.007; and RR 3.27,95%CI0.78-13.64, p=0.1, respectively);there was no difference in the risk of PE(RR1.02,95%CI0.31-3.77,p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery Is associated with higher risk of postoperative DVT and mortality. A similar risk of PE inpatients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline.Ran- domized trials are needed before IVC placement can be recommended. (SurgObesRelatDis 2015;11:268-269.) r 2015 American Society for Metabolic and Bariatric Surgery.
authors.affiliation: Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: kawr@ccf.org.
authors.forename: Roop
authors.initials: R
authors.lastname: Kaw
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Vinay
authors.initials: V
authors.lastname: Pasupuleti
authors.affiliation: Division of Gastrointestinal Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: D
authors.initials: D
authors.lastname: Wayne Overby
authors.affiliation: Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshpande
authors.affiliation: Evidence-Based Practice Center, UCONN/Hartford Hospital, and University of Connecticut School of Pharmacy, Hartford, Connecticut.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.affiliation: Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Postgraduate and Medical Schools, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru; Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Instituto Nacional de Salud, Lima, Peru.
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control
keywords: Bariatric surgery; Inferior vena cava filters; Pulmonary embolism; Venous thromboembolism