Association of Vena Cava Filters and Catheter-Directed Thrombolysis for Deep Vein Thrombosis With Hospital Readmissions

Abstract

OBJECTIVES: The objective was to evaluate all-cause 30 days readmission rate and its association with inferior vena cava filters (IVCF) placement and catheter-directed thrombolysis (CDT) in patients with proximal and caval DVT. BACKGROUND: The rehospitalization rates and its predictors in acute proximal DVT have not been well characterized, including the impact of IVCF placement and CDT.METHODS: Patients with index hospitalization for acute proximal lower extremity DVT were evaluated for unplanned readmission rates at 30 days using Nationwide Readmission Database from 2016 to 2017. We used Cox proportional hazard model to determine the predictors of 30-days readmissions and its association with IVCF and CDT use. RESULTS: 58,306 adult patients were identified with an index hospitalization for acute proximal DVT. 533 patients died during the index admission or within 30 day from initial discharge. The unplanned 30-day rehospitalization rate among survivors of initial hospitalization was 14.7% (95% confidence interval [CI]: 14.5-15.0%). In multivariable analysis, only CDT was associated with a lower hazard for rehospitalization (HR 0.77, 0.71-0.84), whereas IVCF placement (HR 1.26, P<0.001, 95% CI 1.19-1.34), malignancy (HR 1.45, P<0.001, 95% CI 1.34-1.57), and length of stay more than 5 days (HR 1.39, P<0.001, 95% CI 1.33-1.46) were associated with higher readmission rates. CONCLUSIONS: The 30-day unplanned rehospitalization rate continues to be high in patients with acute proximal DVT. CDT was associated with lower rehospitalization rates, while IVCF placement was associated with increased rehospitalization rates. FUNDING STATEMENT: This research was funded by the Division of Cardiovascular Disease, Temple University Hospital. DECLARATION OF INTERESTS: Dr Bashir has equity interest in Thrombolex Inc. Dr. Bikdeli reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to specific brand models of IVC filters. Dr. Anthony J. Comerota is an unpaid member of the Scientific Advisory Board of Thrombolex, Inc. No other disclosures are reported. ETHICS APPROVAL STATEMENT: NRD is publicly available and contains deidentified patient information, hence, the study was exempted from institutional review board assessment.