Elsie Gyang, Mohamed Zayed, E. John Harris, Jason T. Lee, Ronald L. Dalman, Matthew W. Mell
Vascular Surgery, Stanford University Hospital & Clinics, Stanford, CA.
OBJECTIVES: Rates of inferior vena cava filter (IVCF) retrieval have remained suboptimal, in part due to poor follow-up. The goal of our study was to determine demographic and clinical factors predictive of IVCF follow-up care in a university hospital setting.
METHODS: We reviewed 250 consecutive IVCFs placed with the intention of subsequent retrieval between March 2009 and October 2010. Patient demographics, clinical factors, and physician specialty were evaluated. Multivariate logistic regression analysis was performed to identify variables predicting follow-up care.
RESULTS: Of our cohort, 54% received follow-up care; of those, 95% had IVCF retrieval. Major indications for IVCF placement included: 1) prophylaxis for high risk surgery (49%), and 2) venous thromboembolic event with contraindication and/or failure of anticoagulation (42%). Follow-up care was less likely for patients discharged to acute rehabilitation or skilled nursing facilities (p<0.001), those with central nervous system (CNS) pathology (e.g., cerebral hemorrhage or spinal fracture) (p<0.001), and for those whose IVCF was not placed by a vascular surgeon (p<0.001). In a multivariant analysis, discharge home (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.99-8.2; p<0.001), CNS pathology (OR, 0.46; 95% CI, 0.22-0.95; p=0.036), and IVCF placement by the vascular surgery service (OR, 4.7; 95% CI, 2.3-4.9; p<0.001) remained independent predictors of follow-up care. Trauma status and distance of residence did not significantly impact patient follow-up.
CONCLUSIONS: Service-dependent practice paradigms play a critical role in patient follow-up and IVCF retrieval rates. Nevertheless specific patient populations are at risk for poorer subsequent care. Such trends should be factored into institutional quality control goals and patient-directed care.
AUTHOR DISCLOSURES: R. L. Dalman, Nothing to disclose; E. Gyang, Nothing to disclose; E. Harris, Nothing to disclose; J. T. Lee, Nothing to disclose; M. W. Mell, Nothing to disclose; M. Zayed, Nothing to disclose.
Posted April 2012