The Utilization and Outcomes of Inferior Vena Cava Filter Use.

ObjectiveThe utilization of inferior vena cava filters (IVCF) has evolved over time. We explored the indications, complications, and outcomes of patients undergoing IVCF placement.MethodsWe performed a single institution, retrospective review of CPT codes for IVCF placement between 2018 and 2022. Patient characteristics and location were collected. Indications for IVCF placement were categorized. Procedural details were noted and immediate and long-term complications. IVCF removal, total IVCF days, and removal complication were analyzed. Overall mortality, cause of death, and if death occurred the same admission were included.ResultsAn analysis of 347 patients undergoing IVCF placement was performed. Mean patient age was 65 years-old (+/- 16 years), 167 patients (48%) were male, and 28% with current malignancy at time of IVCF placement. 8% of patients had prior DVT, 22% prior PE, 3% prior IVCF. 84% were inpatient on floors, 12% in the ICU, and 4% ambulatory. IVCF were typically placed prior to a surgery with contraindication to anticoagulation (41%), gastrointestinal bleed (15%), failure of anticoagulation (10%), brain bleed (9%), and during venous thrombectomy (8%). The operations included spine procedures (17%) other orthopedic procedures (19%), abdominal procedures (32%), and bariatric interventions (6%). Retrievable filters were placed in 99% of patients. Immediate postoperative complications occurred in 6% of patients. Worsening edema within the same admission, DVT, and filter strut migration in 12% of patients. 29% of patients underwent IVCF removal, of which 10 were unsuccessful and resulted in the filter remaining in place despite an attempt to retrieve it. All-cause mortality at any time point was 21%, with 42% of mortalities occurring during the same admission as the IVC filter placement. Of these mortalities, 4 (1.2%) were secondary to VTE complications. Mortality at 30 days was 8.3% and at 1 year was 15.7%. Death during the admission of IVC filter placement was positively correlated with older age (p = 0.010) and current malignancy was associated with higher mortality (OR 2.2, p < 0.001). Spine surgery patients were 3.8 times more likely to undergo IVCF removal (p = 0.002) as well as patients undergoing ambulatory IVCF placement (p = 0.001).ConclusionIVCF placement has utility in younger patients undergoing elective operations, particularly spine procedures, with contraindication to anticoagulation. Older patients and those with current malignancy are unlikely to benefit given the higher mortality.