Study Evaluates Placement of Inferior Vena Cava Filters Before Bariatric Surgery
June 26, 2019—Findings from a nationwide observational study of prophylactic inferior vena cava filters (IVCFs) placed before bariatric surgery were published by Satyajit Reddy, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2019;12:1153–1160).
The aim of the study was to determine in-hospital mortality, postsurgical thromboembolic events, and health care costs associated with the procedure. The investigators concluded that prophylactic IVCF implantation before bariatric surgery was associated with worse clinical outcomes and increased health care resource utilization.
In the study, investigators identified obese patients who underwent bariatric surgery from January 2005 to September 2015 using the National Inpatient Sample database. Using propensity score matching, outcomes for patients receiving IVCFs were compared with outcomes of those who did not receive IVCFs.
As summarized in JACC: Cardiovascular Interventions, the database included 258,480 patients who underwent bariatric surgery. Of these patients, 1,047 (0.41%) had prophylactic IVCFs implanted.
The investigators found that 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 (PE) (1.4% vs 0.4%; odds ratio, 3.75; 95% confidence interval [CI], 1.25–11.3; P = .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, 1.87–21.4; P < .01), length of stay (median, 3 days vs 2 days; P < .01), and hospital costs (median, $63,000 vs $37,000; P < .01), reported the investigators in JACC: Cardiovascular Interventions.
Riyaz Bashir, MD, the study's Senior Investigator, commented to Endovascular Today, “The effectiveness of IVCF insertion before bariatric surgery for primary prophylaxis against PE is unknown and controversial and is also considered off-label because it lies outside of the official recommendation by the FDA. Our results from this 11-year nationwide observational study suggest that attempting to safeguard bariatric surgery patients from PE-related morbidity and mortality with prophylactic IVCFs is ineffective and should not be performed routinely without further evidence supporting its use. Research and development of other alternative options, such as pharmacologic deep vein thrombosis prophylaxis, mechanical lower extremity compression devices, and early postoperative mobility strategies of these obese surgical patients, may be higher yielding endeavors for protection against venous thromboembolism.” Dr. Bashir is Professor of Medicine and Director of Vascular and Endovascular Medicine at Temple University Hospital in Philadelphia, Pennsylvania.