3:09 PM Abstract No. 52 Risk factors for adverse events following inferior vena cava filter placement: analysis of 69,588 cases

Abstract

Improved inferior vena cava filters (IVCF) have led to liberalization of the indications for insertion, however, sparse data exists identifying risk factors for adverse events (AEs) following IVCF placement. In this study, we identify potential factors and analyzed their association with three quality of care metrics: 30-day readmission, 1-year mortality, and long hospital stay. The New York Statewide Planning and Research Cooperative System, which covers all emergency room visits in New York State, was queried from 2007 to 2014 for emergent IVCF insertion (ICD-9 38.7). The American Hospital Association Dataviewer was used to supplement each procedure with information on the associated facility. High-volume physicians and high-volume hospitals were identified such that each accounted for 25% of all cases. The cutoff for long stay (>22 days) was set such that 25% of cases could be considered long stays. Multivariate analysis was performed to determine adjusted odds ratios, taking into account age, ethnicity, race, insurance, comorbidities, hospital teaching affiliation, hospital setting, and procedure year. A total of 69,588 cases were identified. Of these, 22,401 (32.2%) were identified as following a pulmonary embolism (PE), 33,866 (48.7%) were identified as being related to a deep vein thrombosis (DVT) only, and 13,321 (19.1%) did not have DVT or PE listed as a diagnosis, but were presumably at high risk for a venous thromboembolic event. Female gender and IVCF placement performed more recently were found to be protective for all three quality of care metrics, while procedures performed by high-volume physicians were protective against long hospital stay and 30-day readmissions. Finally, African-American race was found to be associated with poorer outcomes in readmissions and long stay. In the setting of IVCF placement, female gender and more recently placed IVCF were associated with improvement in all three of the quality of care metrics. Procedures performed by high volume physicians were associated with decreased rates of long hospital stay and 30-day readmissions while African-American race was associated with increased rates of those same metrics.