title: Changes in the rate of prophylactic vena cava filter insertion at a university hospital.
abstract: OBJECTIVE
  We previously demonstrated a high rate of prophylactic vena cava filter (VCF) insertion at our institution. We have since attempted to restrict the use of VCF to indications supported by Level-I evidence. This study was designed to evaluate the success of our interventions.
  
  
  METHODS
  All patients receiving VCF between 2007-2009 and 2012-2014 at a university hospital were reviewed. After assessing the use of VCF in the first period, a meeting was convened among the Departments of Radiology, Vascular Surgery and Trauma. Policy was implemented to avoid the inappropriate use of VCF. Data were prospectively collected in the second period to assess the effect of our intervention.
  
  
  RESULTS
  There were 156 VCF placed from 2012 to 2014. VCF was absolutely indicated in 84% of cases, relatively indicated in 9% and prophylactic in 7%. These data contrast our previous experience from 2007 to 2009. In the earlier series, a total of 244 filters were placed, in which 54% of patients had an absolute indication, 14% relative, and 32% prophylactic. There was a significant decrease in filters placed for pure prophylaxis: whereas 76 prophylactic filters were placed between 2007 and 2009, only 11 were placed between 2012 and 2014 (p < 0.0001). No significant differences existed for relatively indicated filters. The department of trauma and surgical critical care (TSCC) observed the most dramatic change in practice. TSCC placed 61 prophylactic VCF between 2007 and 2009 (57% of all filters placed by the department), and 4 prophylactic VCF from 2012 to 2014 (15% of filters placed by TSCC) (p < 0.0001).
  
  
  CONCLUSIONS
  These findings demonstrate a significant change in the attitudes regarding prophylactic VCF insertion between the two periods of study. Further investigations must be performed to assess changes in clinical outcomes that may result from the altered practice at our university.
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery, Health Sciences Center T19-090, New York, USA andrew.smith@stonybrookmedicine.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery, Health Sciences Center T19-090, New York, USA.
authors.forename: Demetri
authors.initials: D
authors.lastname: Adrahtas
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery, Health Sciences Center T19-090, New York, USA.
authors.forename: Doreen
authors.initials: D
authors.lastname: Elitharp
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery, Health Sciences Center T19-090, New York, USA.
authors.forename: Antonios
authors.initials: A
authors.lastname: Gasparis
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery, Health Sciences Center T19-090, New York, USA.
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery, Health Sciences Center T19-090, New York, USA.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tassiopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000517:prevention & control*
keywords: Venous thromboembolism management; caval filter; pulmonary embolism; temporary; venous thromboembolism; venous thromboembolism prophylaxis