PMID- 29180170
OWN - NLM
STAT- MEDLINE
DCOM- 20171211
LR  - 20190114
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 220
DP  - 2017 Dec
TI  - Money well spent? A cost and utilization analysis of prophylactic inferior vena 
      cava filter placement in high-risk trauma patients.
PG  - 105-111
LID - S0022-4804(17)30476-6 [pii]
LID - 10.1016/j.jss.2017.07.004 [doi]
AB  - BACKGROUND: Inferior vena cava filters (IVCF) for venous thromboembolic 
      prophylaxis in high-risk trauma patients is a controversial practice. Utilization 
      of IVCF prophylaxis was evaluated at a level 1 trauma center. Daily cost of IVCF 
      prophylaxis, time to IVCF, duration between IVCF and chemoprophylaxis, and number 
      of patients needed to treat (NNT) to prevent pulmonary embolism (PE) was 
      calculated. METHODS: A retrospective review of prophylactic IVCF over a 5-year 
      period (2010-2014). Demographic, physiologic, injury, procedural, and outcome 
      data were abstracted from the administrative trauma database. Medicare fees and 
      days without chemoprophylaxis were used to determine daily IVCF cost. NNT was 
      calculated using PE events in a cohort without IVCF. RESULTS: Over the 5-year 
      period, 146 patients with mean age 56.3 y (SD +/- 24.2), 67.8% male, underwent 
      prophylactic IVCF. Predominant mechanisms of injuries were falls (45.9%) and 
      motor vehicle accidents (20.5%) with median Injury Severity Score of 25 
      (intraquartile range [IQR] 16-29) and head Abbreviated Injury Score of 3 (IQR 
      3-5). Most common operative interventions required in 24.7% were orthopedic 
      (25.3%) and neurosurgical (21.9%). Median time to IVCF was 78 h (IQR 48-144). 
      Most common IVCF indications were closed head injury (48.6%) and spinal injuries 
      (30.8%). Median time to administration of chemoprophylaxis was 96 h after IVCF 
      (IQR 24-192) in 57.5%. Median IVCF cost was $759/d (IQR $361-$1897) compared with 
      $4.32 for chemoprophylaxis. PE occurred in 0.26% without IVCF. PE did not occur 
      with prophylactic IVCF. Estimated NNT was 379 (95% CI 265, 661). CONCLUSIONS: 
      Prophylactic IVCF placement is a costly practice with relatively low benefit. 
      Anticipated time without chemoprophylaxis and patient criteria should be 
      considered before routine IVCF placement.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Carlin, Margo Nicole
AU  - Carlin MN
AD  - Department of Trauma & Critical Care, Delray Medical Center, Nova Southeastern 
      University, Delray Beach, Florida; Department of General Surgery, Larkin 
      Community Hospital, Nova Southeastern University, South Miami, Florida. 
      Electronic address: margoca@pcom.edu.
FAU - Daneshpajouh, Alireza
AU  - Daneshpajouh A
AD  - Department of Trauma & Critical Care, Delray Medical Center, Nova Southeastern 
      University, Delray Beach, Florida; Department of General Surgery, Larkin 
      Community Hospital, Nova Southeastern University, South Miami, Florida.
FAU - Catino, Joseph
AU  - Catino J
AD  - Department of Trauma & Critical Care, Delray Medical Center, Nova Southeastern 
      University, Delray Beach, Florida.
FAU - Bukur, Marko
AU  - Bukur M
AD  - Department of Acute Care Surgery, Bellevue Hospital Center, New York University 
      School of Medicine, New York New York.
LA  - eng
PT  - Journal Article
DEP - 20170726
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Accidental Falls/economics
MH  - Accidents, Traffic/economics
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/therapeutic use
MH  - *Costs and Cost Analysis
MH  - Female
MH  - Head Injuries, Closed/surgery
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Medicare
MH  - Middle Aged
MH  - Pulmonary Embolism/*prevention & control
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Spinal Injuries/surgery
MH  - Time Factors
MH  - Trauma Centers/economics
MH  - United States
MH  - Vena Cava Filters/*economics/*statistics & numerical data
MH  - Vena Cava, Inferior/*surgery
OTO - NOTNLM
OT  - Cost analysis
OT  - Prophylactic vena cava filter
OT  - Pulmonary embolism
OT  - Trauma
OT  - Venous thromboembolism
EDAT- 2017/11/29 06:00
MHDA- 2017/12/12 06:00
CRDT- 2017/11/29 06:00
PHST- 2017/03/09 00:00 [received]
PHST- 2017/06/29 00:00 [revised]
PHST- 2017/07/03 00:00 [accepted]
PHST- 2017/11/29 06:00 [entrez]
PHST- 2017/11/29 06:00 [pubmed]
PHST- 2017/12/12 06:00 [medline]
AID - S0022-4804(17)30476-6 [pii]
AID - 10.1016/j.jss.2017.07.004 [doi]
PST - ppublish
SO  - J Surg Res. 2017 Dec;220:105-111. doi: 10.1016/j.jss.2017.07.004. Epub 2017 Jul 
      26.