Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery: Insights From the National Inpatient Sample

Satyajit Reddy, Chad J. Zack, Vladimir Lakhter, Vikas Aggarwal, Henry A. Pitt, Michael A. Edwards, Huaqing Zhao, Riyaz Bashir

Research output: Contribution to journalArticle

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Abstract

Objectives: The aim of this study was to determine in-hospital mortality, post-surgical thromboembolic events, and health care costs associated with the placement of prophylactic inferior vena cava filters (IVCFs) prior to bariatric surgery. Background: The role of prophylactic IVCFs prior to bariatric surgery is controversial, and the nationwide clinical outcomes associated with this practice are unknown. Methods: This observational study used the National Inpatient Sample database to identify obese patients who underwent bariatric surgery from January 2005 to September 2015. Using propensity score matching, outcomes associated with patients receiving prophylactic IVCFs prior to their bariatric surgery were compared with those among patients who did not receive IVCFs. Results: A total of 258,480 patients underwent bariatric surgery, of whom 1,047 (0.41%) had prophylactic IVCFs implanted. Patients with prophylactic IVCFs compared with those without IVCFs had a significantly higher rate of the combined endpoint of in-hospital mortality or pulmonary embolism (1.4% vs. 0.4%; odds ratio: 3.75; 95% confidence interval [CI]: 1.25 to 11.30; p = 0.019). Additionally, prophylactic IVCFs were associated with higher rates of lower extremity or caval deep vein thrombosis (1.8% vs. 0.3%; odds ratio: 6.33; 95% CI: 1.87 to 21.4; p < 0.01), length of stay (median 3 days vs. 2 days; p < 0.01), and hospital charges (median $63,000 vs. $37,000; p < 0.01). Conclusions: In this nationwide observational study, prophylactic IVCF implantation prior to bariatric surgery was associated with worse clinical outcomes and increased health care resource utilization.

Original languageEnglish (US)
Pages (from-to)1153-1160
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume12
Issue number12
DOIs
StatePublished - Jun 24 2019

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Vena Cava Filters
Bariatric Surgery
Inpatients
Hospital Mortality
Observational Studies
Odds Ratio
Patient Acceptance of Health Care
Confidence Intervals
Hospital Charges
Propensity Score
Venae Cavae
Health Resources
Pulmonary Embolism
Venous Thrombosis
Health Care Costs
Lower Extremity
Length of Stay
Databases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Reddy, Satyajit ; Zack, Chad J. ; Lakhter, Vladimir ; Aggarwal, Vikas ; Pitt, Henry A. ; Edwards, Michael A. ; Zhao, Huaqing ; Bashir, Riyaz. / Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery : Insights From the National Inpatient Sample. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 12. pp. 1153-1160.
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title = "Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery: Insights From the National Inpatient Sample",
abstract = "Objectives: The aim of this study was to determine in-hospital mortality, post-surgical thromboembolic events, and health care costs associated with the placement of prophylactic inferior vena cava filters (IVCFs) prior to bariatric surgery. Background: The role of prophylactic IVCFs prior to bariatric surgery is controversial, and the nationwide clinical outcomes associated with this practice are unknown. Methods: This observational study used the National Inpatient Sample database to identify obese patients who underwent bariatric surgery from January 2005 to September 2015. Using propensity score matching, outcomes associated with patients receiving prophylactic IVCFs prior to their bariatric surgery were compared with those among patients who did not receive IVCFs. Results: A total of 258,480 patients underwent bariatric surgery, of whom 1,047 (0.41{\%}) had prophylactic IVCFs implanted. Patients with prophylactic IVCFs compared with those without IVCFs had a significantly higher rate of the combined endpoint of in-hospital mortality or pulmonary embolism (1.4{\%} vs. 0.4{\%}; odds ratio: 3.75; 95{\%} confidence interval [CI]: 1.25 to 11.30; p = 0.019). Additionally, prophylactic IVCFs were associated with higher rates of lower extremity or caval deep vein thrombosis (1.8{\%} vs. 0.3{\%}; odds ratio: 6.33; 95{\%} CI: 1.87 to 21.4; p < 0.01), length of stay (median 3 days vs. 2 days; p < 0.01), and hospital charges (median $63,000 vs. $37,000; p < 0.01). Conclusions: In this nationwide observational study, prophylactic IVCF implantation prior to bariatric surgery was associated with worse clinical outcomes and increased health care resource utilization.",
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Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery : Insights From the National Inpatient Sample. / Reddy, Satyajit; Zack, Chad J.; Lakhter, Vladimir; Aggarwal, Vikas; Pitt, Henry A.; Edwards, Michael A.; Zhao, Huaqing; Bashir, Riyaz.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 12, 24.06.2019, p. 1153-1160.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery

T2 - Insights From the National Inpatient Sample

AU - Reddy, Satyajit

AU - Zack, Chad J.

AU - Lakhter, Vladimir

AU - Aggarwal, Vikas

AU - Pitt, Henry A.

AU - Edwards, Michael A.

AU - Zhao, Huaqing

AU - Bashir, Riyaz

PY - 2019/6/24

Y1 - 2019/6/24

N2 - Objectives: The aim of this study was to determine in-hospital mortality, post-surgical thromboembolic events, and health care costs associated with the placement of prophylactic inferior vena cava filters (IVCFs) prior to bariatric surgery. Background: The role of prophylactic IVCFs prior to bariatric surgery is controversial, and the nationwide clinical outcomes associated with this practice are unknown. Methods: This observational study used the National Inpatient Sample database to identify obese patients who underwent bariatric surgery from January 2005 to September 2015. Using propensity score matching, outcomes associated with patients receiving prophylactic IVCFs prior to their bariatric surgery were compared with those among patients who did not receive IVCFs. Results: A total of 258,480 patients underwent bariatric surgery, of whom 1,047 (0.41%) had prophylactic IVCFs implanted. Patients with prophylactic IVCFs compared with those without IVCFs had a significantly higher rate of the combined endpoint of in-hospital mortality or pulmonary embolism (1.4% vs. 0.4%; odds ratio: 3.75; 95% confidence interval [CI]: 1.25 to 11.30; p = 0.019). Additionally, prophylactic IVCFs were associated with higher rates of lower extremity or caval deep vein thrombosis (1.8% vs. 0.3%; odds ratio: 6.33; 95% CI: 1.87 to 21.4; p < 0.01), length of stay (median 3 days vs. 2 days; p < 0.01), and hospital charges (median $63,000 vs. $37,000; p < 0.01). Conclusions: In this nationwide observational study, prophylactic IVCF implantation prior to bariatric surgery was associated with worse clinical outcomes and increased health care resource utilization.

AB - Objectives: The aim of this study was to determine in-hospital mortality, post-surgical thromboembolic events, and health care costs associated with the placement of prophylactic inferior vena cava filters (IVCFs) prior to bariatric surgery. Background: The role of prophylactic IVCFs prior to bariatric surgery is controversial, and the nationwide clinical outcomes associated with this practice are unknown. Methods: This observational study used the National Inpatient Sample database to identify obese patients who underwent bariatric surgery from January 2005 to September 2015. Using propensity score matching, outcomes associated with patients receiving prophylactic IVCFs prior to their bariatric surgery were compared with those among patients who did not receive IVCFs. Results: A total of 258,480 patients underwent bariatric surgery, of whom 1,047 (0.41%) had prophylactic IVCFs implanted. Patients with prophylactic IVCFs compared with those without IVCFs had a significantly higher rate of the combined endpoint of in-hospital mortality or pulmonary embolism (1.4% vs. 0.4%; odds ratio: 3.75; 95% confidence interval [CI]: 1.25 to 11.30; p = 0.019). Additionally, prophylactic IVCFs were associated with higher rates of lower extremity or caval deep vein thrombosis (1.8% vs. 0.3%; odds ratio: 6.33; 95% CI: 1.87 to 21.4; p < 0.01), length of stay (median 3 days vs. 2 days; p < 0.01), and hospital charges (median $63,000 vs. $37,000; p < 0.01). Conclusions: In this nationwide observational study, prophylactic IVCF implantation prior to bariatric surgery was associated with worse clinical outcomes and increased health care resource utilization.

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