Retrievable inferior vena cava filters in trauma patients: factors that influence removal rate and an argument for institutional protocols

• Published in: The American journal of surgery 2012-03, Vol.203 (3), p.297-302
• Main Authors: Albrecht, Roxie M., M.D, Garwe, Tabitha, Ph.D, Carter, Sandra M., M.A., M.P.H, Maurer, Adrian J., B.S
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Anticoagulants; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular disease; Case-Control Studies; Clinical Protocols; Comorbidity; Device Removal - standards; Device Removal - statistics & numerical data; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Embolism; Embolisms; Female; Filters; General aspects; Hospitals; Humans; Injuries; Logistic Models; Male; Medical sciences; Middle Aged; Nursing; Patients; Pneumology; Protocol; Pulmonary embolism; Pulmonary Embolism - etiology; Pulmonary Embolism - prevention & control; Pulmonary embolisms; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Quality Improvement - statistics & numerical data; Retrievable vena cava filter; Retrieval; Retrieval rates; Retrospective Studies; Surgery; Thrombosis; Trauma; Trauma Centers - standards; Vena Cava Filters; Venous thromboembolism; Wounds and Injuries - complications
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.09.006

Abstract Background Trauma patients at risk for pulmonary embolism, but with contraindications for anticoagulation therapy, often have retrievable inferior vena cava filters (RIVCF) placed. This study evaluated factors associated with the recovery rate of the device (RIVCFs) with the goal of developing an institutional protocol to ensure timely removal. Methods This was a case-control study of 88 trauma patients who underwent RIVCF placement at a level 1 trauma center between 2006 and 2010. Results The overall retrieval rate was 58%, declining from 89% in 2006 to 50% in 2009. Factors independently associated with filter nonretrieval included increasing age, increase in number of providers, comorbidity, hospital discharge from the intensive care unit, and discharge to a long-term acute care facility or skilled nursing facility. In 2010, a protocol was implemented and the retrieval rate increased to 73%. Conclusions In a large institution where a number of providers may be responsible for filter management, implementation of a protocol appears to improve retrieval rates.