John N Afthinos, MD, Karen E Gibbs, MD. Staten Island University Hospital
The prophylactic use of inferior vena cava (IVC) filters for patients undergoing elective bariatric surgery has been reported in the literature at variable rates. In 2010 a landmark study demonstrated no benefit, but rather increased complication rates from the use of prophylactic IVC filters. We sought to evaluate the use and complication rates of prophylactic IVC filters in this clinical setting through the use of a large national database.
The National Inpatient Sample (NIS) Database was queried from 2005 to 2011 for patients undergoing elective, primary bariatric surgery. Operations included were gastric bypass (LRYGB), gastric band (LAGB), mini-LRYGB and biliopancreatic diversion-duodenal switch (BPDDS). Patients undergoing revisional surgery were excluded from this study. The patients were analyzed for comorbid conditions, incidence of prophylactic IVC filter placement, length of stay (LOS) and post-operative morbidity and mortality. Annual utilization of prophylactic IVC filter placement was also measured. Multivariate regression analyses were performed to evaluate for risk factors for placement of IVC filter and for factors leading to in-hospital post-operative mortality.
We identified 741,794 patients of which 454,599 (61%) underwent LRYGB; 152,867 (21%) underwent LAGB; 64,209 (9%) underwent mini-LRYGB and 70,119 (9%) underwent BPDDS. The annual utilization of IVC filters is shown in Table 1. Risk factors for placement of IVC filter prophylactic included: mini-LRYGB (OR 1.7, p < 0.001), CKD (OR 2.3, p < 0.001), severe liver disease (OR 4.4, p = 0.001), history of DVT to lower extremity unspecified location (OR 19, p < 0,001), to the proximal leg (OR 31, p < 0.001) and to distal leg (OR 9, p < 0.001). The presence of a prophylactic IVC filter increased the risk of post-operative mortality by OR 1.9, p < 0.001.
Conclusions: Overall, the rate of prophylactic IVC filter use is low. Some of the highest utilization occurred in 2010 and then decreased significantly. The use of a prophylactic IVC filter increased the risk of post-operative mortality. The data speaks against the use of prophylactic IVC filters in bariatric surgery patients.