Paul D Stein1, Fadi Matta1, Mary J Hughes1. 1. Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, United States.
Abstract
BACKGROUND: Which patients with fractures, if any, have a lower mortality with prophylactic inferior vena cava filters has yet to be established. The purpose of this investigation is to determine if patients with low-risk fractures might benefit from a prophylactic inferior vena cava filter. METHODS: Administrative data was analyzed from the National (Nationwide) Inpatient Sample using ICD-9-CM codes. Included patients were aged 18 years or older with a primary diagnosis of non-complex fracture of the pelvis, or fracture of the femuralone, or fracture of the tibia and/or fibula. RESULTS: From 2003-2012, 1,479,039 patients were hospitalized with low-risk fracture. The vast majority of patients with fracture, 1,461,378 of 1,479,039 (98.8%) did not receive an inferior vena cava filter. Among those who did not receive a filter, 1,446,489 of 1,461,378 (99.0%) did not develop deep venous thrombosis or pulmonary embolism. Pulmonary embolism without a filter occurred in 7207 of 1,461,378 (0.5%) and deep venous thrombosis occurred in 7682 of 1,461,378 (0.5%). Total in-hospital all-cause mortality in those who did not receive a filter was 15,683 of 1,461,378 (1.1%). An inferior vena cava filter was inserted in 17,661 of 1,479,039 (1.2%) of patients with fractures. Most of those who received an inferior vena cava filter, 12,025 of 17,661 (68.1%) did not develop pulmonary embolism or deep venous thrombosis. Total in-hospital all-cause mortality in all patients with an inferior vena cava filter was 516 of 17,661 (2.9%). CONCLUSION: The evidence is against the use of a prophylactic inferior cava vena filter in patients with a non-complex pelvic fracture or single fracture of the femur or fracture of the tibia and/or fibula.
BACKGROUND: Which patients with fractures, if any, have a lower mortality with prophylactic inferior vena cava filters has yet to be established. The purpose of this investigation is to determine if patients with low-risk fractures might benefit from a prophylactic inferior vena cava filter. METHODS: Administrative data was analyzed from the National (Nationwide) Inpatient Sample using ICD-9-CM codes. Included patients were aged 18 years or older with a primary diagnosis of non-complex fracture of the pelvis, or fracture of the femuralone, or fracture of the tibia and/or fibula. RESULTS: From 2003-2012, 1,479,039 patients were hospitalized with low-risk fracture. The vast majority of patients with fracture, 1,461,378 of 1,479,039 (98.8%) did not receive an inferior vena cava filter. Among those who did not receive a filter, 1,446,489 of 1,461,378 (99.0%) did not develop deep venous thrombosis or pulmonary embolism. Pulmonary embolism without a filter occurred in 7207 of 1,461,378 (0.5%) and deep venous thrombosis occurred in 7682 of 1,461,378 (0.5%). Total in-hospital all-cause mortality in those who did not receive a filter was 15,683 of 1,461,378 (1.1%). An inferior vena cava filter was inserted in 17,661 of 1,479,039 (1.2%) of patients with fractures. Most of those who received an inferior vena cava filter, 12,025 of 17,661 (68.1%) did not develop pulmonary embolism or deep venous thrombosis. Total in-hospital all-cause mortality in all patients with an inferior vena cava filter was 516 of 17,661 (2.9%). CONCLUSION: The evidence is against the use of a prophylactic inferior cava vena filter in patients with a non-complex pelvic fracture or single fracture of the femur or fracture of the tibia and/or fibula.
Authors: Joseph Cuschieri; Brad Freeman; Grant O'Keefe; Brian G Harbrecht; Paul Bankey; Jeffrey L Johnson; Joseph P Minei; Jason Sperry; Michael West; Avery Nathens; Ernest E Moore; Ronald V Maier Journal: J Trauma Date: 2008-10