title: Hospital Variation and Patient Characteristics Associated With Vena Cava Filter Utilization.
abstract: BACKGROUND
  There is a wide variation in the use of vena cava filter (VCF).
  
  
  OBJECTIVE
  This study assessed the hospital and patient characteristics associated with VCF use in deep vein thrombosis (DVT) and pulmonary embolism (PE).
  
  
  METHODS
  Inpatient discharge data from all acute care hospitals with DVT/PE during 2008-2014 in Kentucky were used. Hierarchical logistic regression models were used to evaluate the relationships of study variables with VCF use.
  
  
  RESULTS
  During the study period, 81,922 discharges for DVT/PE were observed and 10.5% of these received a VCF. This included 12,083 cases of PE+DVT, 18,571 cases of PE only, and 51,268 cases of DVT only. VCF use among these groups was 22.7%, 6.0%, and 7.8%, respectively. In adjusted analyses, VCF use was associated with increasing age, indicating that those over age 65 were twice as likely to receive a filter compared with the reference (21-25 y old) group. Significant comorbidities associated with VCF use included cancer, liver disease, cerebrovascular disease, atrial fibrillation, anemia, and concurrent bleeding. Lower extremity, proximal DVTs, and patients receiving thrombolytic therapy or embolectomy, those having surgery, and those who were unstable or had trauma, were also more likely to receive a filter. Among cancer types, brain and metastatic tumors were significantly associated with VCF use. Between-hospital variation after controlling for all covariates was 7.1%.
  
  
  CONCLUSIONS
  There was high variation in the use of VCFs. Several high-risk subgroups were more likely to use VCFs including older adults and those with cancer and concurrent bleeding.
authors.affiliation: Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Brown
authors.forename: Jeffery C
authors.initials: JC
authors.lastname: Talbert
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007629:Kentucky; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011655:Pulmonary Embolism / Q000601:surgery*; D012307:Risk Factors; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D020246:Venous Thrombosis / Q000601:surgery*