Author + information
- Received January 28, 2019
- Revision received March 28, 2019
- Accepted April 2, 2019
- Published online June 17, 2019.
- Satyajit Reddy, MDa,
- Chad J. Zack, MDb,
- Vladimir Lakhter, DOc,
- Vikas Aggarwal, MDd,
- Henry A. Pitt, MDe,
- Michael A. Edwards, MDf,
- Huaqing Zhao, PhDg and
- Riyaz Bashir, MDh,∗ ()
- aDivision of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- bDepartment of Cardiology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
- cDivision of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- dDivision of Cardiology, University of Michigan Medical School, Ann Arbor, Michigan
- eDepartment of Surgery, Lewis Katz School of Medicine of Temple University, Philadelphia, Pennsylvania
- fDepartment of Surgery, Division of General and Minimally Invasive Surgery, Section of Bariatric Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- gDepartment of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- hDepartment of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Riyaz Bashir, Lewis Katz School of Medicine at Temple University, Division of Cardiovascular Diseases, 3401 North Broad Street (9 PP), Philadelphia, Pennsylvania 19140.
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.
- deep vein thrombosis
- inferior vena cava filters
- pre-operative risk assessment
- pulmonary embolism
- venous thromboembolism
This study was funded by the Cardiovascular Division, Lewis Katz School of Medicine at Temple University Hospital. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Dr. Bashir has equity interest in Thrombolex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 28, 2019.
- Revision received March 28, 2019.
- Accepted April 2, 2019.
- 2019 American College of Cardiology Foundation
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