Mary Jiayi Tao1, Janice M Montbriand2, Naomi Eisenberg3, Kenneth W Sniderman4, Graham Roche-Nagle5. 1. Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada. 3. Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 4. Division of Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada. 5. Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: graham.roche-nagle@uhn.ca.
Abstract
OBJECTIVE: The aim of this study was to investigate the practice pattern of inferior vena cava (IVC) filters and to determine factors predictive of filter retrievals at a multicenter, tertiary care institution. METHODS: A retrospective review of all IVC filter procedures performed between January 2001 and July 2013 was conducted. Data collected included demographics, venous thromboembolism risk factors, medical comorbidities, insertional and retrieval characteristics, referring services, complications, discharge, and follow-up management. RESULTS: During the study period, 1123 IVC filter procedures were performed; 69% (n = 810) were insertions and 31% (n = 313) were retrievals. Of the patients receiving filters, the average age was 61.4 years, and 53.3% were male. Overall, 408 filters (51.5%) were placed with absolute indications, 214 (27.0%) for relative indications, 138 (17.4%) prophylactically, and 32 (4.0%) for reasons outside the established guidelines. Of the 663 retrievable filters, successful removal rate was 41.6% (n = 276); the mean time to first retrieval attempt was 76.4 days (standard deviation = 110.5). Documentation of the filter was present in 342 (43.1%) discharge summaries, and outlined instructions for filter management were seen in 129 (16.3%) cases. Significant predictors of filter removal were thrombosis follow-up (odds ratio [OR], 6.7; P < .01) and the ordering service as filters ordered by medical specialties were less likely to be retrieved than filters ordered by surgical specialties (OR, 0.53; P = .04). Compared with discharge summaries without filter management instructions, those with plans had higher filter retrieval rates (OR, 3.74; P < .00). Filter-related complications was observed in 57 patients. CONCLUSIONS: Given the established complications relating to long indwelling times and recent Food and Drug Administration guidelines, a multidisciplinary and systematic follow-up protocol needs to be implemented to optimize filter retrieval rates and to ensure exemplary quality of care.
OBJECTIVE: The aim of this study was to investigate the practice pattern of inferior vena cava (IVC) filters and to determine factors predictive of filter retrievals at a multicenter, tertiary care institution. METHODS: A retrospective review of all IVC filter procedures performed between January 2001 and July 2013 was conducted. Data collected included demographics, venous thromboembolism risk factors, medical comorbidities, insertional and retrieval characteristics, referring services, complications, discharge, and follow-up management. RESULTS: During the study period, 1123 IVC filter procedures were performed; 69% (n = 810) were insertions and 31% (n = 313) were retrievals. Of the patients receiving filters, the average age was 61.4 years, and 53.3% were male. Overall, 408 filters (51.5%) were placed with absolute indications, 214 (27.0%) for relative indications, 138 (17.4%) prophylactically, and 32 (4.0%) for reasons outside the established guidelines. Of the 663 retrievable filters, successful removal rate was 41.6% (n = 276); the mean time to first retrieval attempt was 76.4 days (standard deviation = 110.5). Documentation of the filter was present in 342 (43.1%) discharge summaries, and outlined instructions for filter management were seen in 129 (16.3%) cases. Significant predictors of filter removal were thrombosis follow-up (odds ratio [OR], 6.7; P < .01) and the ordering service as filters ordered by medical specialties were less likely to be retrieved than filters ordered by surgical specialties (OR, 0.53; P = .04). Compared with discharge summaries without filter management instructions, those with plans had higher filter retrieval rates (OR, 3.74; P < .00). Filter-related complications was observed in 57 patients. CONCLUSIONS: Given the established complications relating to long indwelling times and recent Food and Drug Administration guidelines, a multidisciplinary and systematic follow-up protocol needs to be implemented to optimize filter retrieval rates and to ensure exemplary quality of care.