Efficacy of prophylactic inferior vena cava filter placement in bariatric surgery

Abstract

Background: To determine whether prophylactic placement of an inferior vena cava (IVC) filter in bariatric patients deemed to be at high risk is effective in reducing their risk of pulmonary embolism. The study was performed at a bariatric center in a community hospital.

Methods: This was a retrospective study of all patients in the Hurley Bariatric Center database who had undergone surgery from April 2000 to June 2006. We compared the incidence of deep venous thrombosis (DVT), pulmonary embolism (PE), and all-cause perioperative mortality in patients who received prophylactic IVC filters and those who did not. Patients received prophylactic filters for risk factors identified in their preoperative evaluation. The charts and electronic medical records were reviewed retrospectively for any DVTs, PEs, and deaths within 30 days.

Results: A total of 1851 patients were identified as low risk and did not receive an IVC filter. Among these patients, 12 DVTs, 11 PEs, and 4 deaths occurred. Of the 248 high-risk patients who received IVC filters, 3 DVTs, 2 PEs, and 2 deaths occurred. The difference in the rates of PE was not significant (P = 0.69).

Conclusion: The incidence of PE in the high-risk group was not significantly different from that of the low-risk group. Thus, the use of prophylactic IVC filters reduces the risk of PE in high-risk patients, a group known to have a much greater incidence of morbidity and mortality, to a rate comparable to the baseline risk of a low-risk group. Additional study is necessary to better define the risk groups.