Clinical Practice and Volume Trends of Inferior Vena Cava Filter Utilization at a Single Tertiary Care Center over a 19 Year Period

Abstract

Background

To investigate clinical practice and volume trends of inferior vena cava filter (IVCF) utilization at a single institution over an extended time period and identify potential factors affecting clinical decision for placement, follow-up, and retrieval.

Methods

An institutional database was queried for IVCFs placed from 2000-2018 based on CPT codes. Medical records were reviewed to evaluate demographics, economic status, placement indication, filter type, follow-up evaluation for retrieval, and retrieval success rates. Statistical analysis was performed using SPSS, employing t-tests for continuous and χ2 for categorical variables.

Results

A total of 3,915 IVCFs were placed from 2000-2018. The placement of IVCF steadily increased from 2000 (127 filters/year) peaking in 2010 (371 filters/year) representing a 292% increase in IVCF utilization. Since 2010, the number of IVCF placed has steadily declined until 2016-2018, with a 426% decrease from the peak. In a subgroup of IVCFs placed for prophylaxis, total volume trends paralleled a shift in clinical indications peaking in 2010 accounting for 45% of all IVCF placed, and then decreasing since 2013-2018 to ≤10%. Overall, 989 (25.3%) permanent filters and 2,926 (74.7%) retrievable filters were placed over the entire study period. Prior to dedicated efforts to implement retrieval follow-up visits, successful retrieval rates were ∼1% from 2000-2006, increasing to ∼10-15% from 2007-2015, 36.7% in 2016, 40.2% in 2017, and 40.3% in 2018 following implementation of more active retrieval follow-up protocols. Predictors for lack of evaluation for IVCF retrieval included extended length of stay (p=0.004) and geographic distance (<0.001).

Conclusions

The use of IVCF over the past 19-years at our institution reflects increased utilization (2000-2010), corresponding to an increase in prophylactic placement to decreasing total volume (2011-2018), largely attributable to decreased prophylactic filter placement. Improved retrieval rates were seen after implementation of an active IVCF retrieval program.