title: Retrievable inferior vena cava filters in geriatric trauma: Is there an age bias?
abstract: BACKGROUND
  Trauma patients are at increased risk for developing venous thromboembolic (VTE) disease. The EAST (Eastern Association for the Surgery of Trauma) practice management guidelines identified risk factors for VTE, as well as indications for prophylactic inferior vena cava filters (IVCF). In a 2009 study, our institution found a 26% retrieval rate for IVCF. Lack of retrieval was most consistently due to lack of follow-up. Our study is a follow-up analysis for retrieval rate of IVCF, since the formation of a geriatric trauma service. We anticipated that geriatric trauma patients would have a lower rate of IVCF retrieval compared to the general trauma patient.
  
  
  METHODS
  Our study population consisted of trauma patients admitted from January 2008 to August 2013, with documented VTE or high risk for VTE with contraindication to anticoagulation.
  
  
  METHODS
  IVCF placed in trauma patients.
  
  
  METHODS
  permanent filters, retrievable filters placed permanently, non-trauma patients, superior vena cava filters and patients who died before discharge.
  
  
  RESULTS
  During the study period, 160 trauma patients had an IVCF placed, of which 147 survived and were discharged. Of those patients, 66% (97/147) were planned for retrieval. Overall, the retrieval rate was 34% (33/97). Following age categorization, rates were 47% (30/64) and 9% (3/33) for those <65 and >/=65 years old, respectively. Applying Fisher's Exact Test to a crosstab of planned retrieval by age category yielded a statistically significant difference, p<0.0005 at alpha=0.05. In the geriatric population with IVCFs not retrieved, 23% (7/30) died and 67% (20/30) were lost to follow-up.
  
  
  CONCLUSIONS
  IVCF plays a critical role in the management of trauma patients with VTE, particularly the geriatric population. Since our 2009 study, we have improved nearly ten percentage points (26% to 34%); however, we exposed an age bias with retrieval rate being lower in patients >/=65 compared to those <65 (9% vs. 47%).
authors: General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States. Electronic address: durias@conemaugh.org.
authors: Daniel
authors: D
authors: Urias
authors: General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States. Electronic address: jsilvis@conemaugh.org.
authors: Jennifer
authors: J
authors: Silvis
authors: General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States. Electronic address: lmesropy@conemaugh.org.
authors: Lusine
authors: L
authors: Mesropyan
authors: General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States. Electronic address: eoberlan@conemaugh.org.
authors: Emma
authors: E
authors: Oberlander
authors: Research Associate Conemaugh Memorial Medical Center, Johnstown, PA, United States. Electronic address: tsimunic@conemaugh.org.
authors: Thomas
authors: T
authors: Simunich
authors: Vascular Surgeon Valley Health Winchester, VA, United States. Electronic address: jftretter@gmail.com.
authors: James
authors: J
authors: Tretter
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005853:Geriatrics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Geriatric; Inferior vena cava filter; Retrievable; Trauma center