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 PS140. Secondary Vena Cava Filter Insertion During Surgical Procedures: Characterization and Comparison with Rates of Perioperative Venous Thromboembolism

​Yazan Duwayri1, Robert C. Allen2, Jennifer Avise2, Luke P. Brewster2, Ravi R. Rajani2, Ravi K. Veeraswamy2, Matthew S. Edwards3, Philip P. Goodney4, Matthew A. Corriere1
1Emory University School of Medicine/Atlanta VA Medical Center, Atlanta, GA; 2Emory University School of Medicine, Atlanta, GA; 3Wake Forest School of Medicine, Winston-Salem, NC; 4Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVES: Vena cava filter (VCF) insertion is sometimes performed as a secondary procedure during operations unrelated to treatment of venous thromboembolism (VTE). This approach has not been characterized and limited evidence exists to support it.

METHODS: VCF insertions were identified within the 2005-2010 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) Participant Use Datafile. Secondary VCF insertions, performed during the same anesthetic as a primary procedure unrelated to VTE treatment, were classified based on primary CPT codes. Primary CPT codes were then used to compare overall rates of secondary VCF insertion and postoperative DVT.

RESULTS: 364 patients met the inclusion criteria. Primary bariatric surgery procedures accounted for the largest number of VCF insertions (n=174) followed by colon (n=41), hepatobiliary (n=14), peripheral vascular (n=14), gastric (non-bariatric) (n=13), and amputation (n=10) procedures. Rates of VCF utilization exceeded incidence of postoperative DVT for bariatric (2.5 vs. 1.6/1000) and endocrine (3.5 vs. 3.0/1,000) procedures.

CONCLUSIONS: Secondary VCF insertion may be over-utilized, particularly in prophylactic scenarios where DVT risk is low. Further critical evaluation of VCF use is warranted, particularly where utilization rates exceed DVT incidence.

AUTHOR DISCLOSURES: R. C. Allen, Nothing to disclose; J. Avise, Nothing to disclose; L. P. Brewster, Nothing to disclose; M. A. Corriere, Nothing to disclose; Y. Duwayri, Nothing to disclose; M. S. Edwards, Nothing to disclose; P. P. Goodney, Nothing to disclose; R. R. Rajani, Nothing to disclose; R. K. Veeraswamy, Nothing to disclose.

Procedure Category
Primary Cases (N)
Secondary VCF Utilization Rate (Per 1,000 Cases)
DVT Rate (Per 1,000 Cases)
Bariatric
69,814
2.49
1.58
Colon
108,898
0.38
7.77
Hepatobiliary
87,454
0.16
2.24
Peripheral vascular
22,445
0.62
7.31
Gastric (non-bariatric)
7,972
1.63
7.65
Amputation
6,312
1.58
8.40
Abdominal exploratory
7,811
1.28
13.95
Aortic
7,173
1.25
9.34
Hernia repair
51,520
0.16
1.98
Skin/soft tissue
3,463
2.30
4.90
Endocrine
2,019
3.47
2.97
Esophageal
13,143
0.46
5.25
Small bowel
14,454
0.42
12.94

 

Posted April 2012

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