• Nancy J Birkmeyer, Jonathan F Finks, Wayne J English, Arthur M Carlin, Abdelkader A Hawasli, Jeffrey A Genaw, Michael H Wood, David A Share, John D Birkmeyer, and Michigan Bariatric Surgery Collaborative.
• Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. nbirkmey@umich.edu
• J Hosp Med. 2013 Apr 1; 8 (4): 173-7.

BackgroundThe United States Food and Drug Administration recently issued a warning about adverse events in patients receiving inferior vena cava (IVC) filters.ObjectiveTo assess relationships between IVC filter insertion and complications while controlling for differences in baseline patient characteristics and medical venous thromboembolism prophylaxis.DesignPropensity-matched cohort study.SettingThe prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative.PatientsBariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012.InterventionProphylactic IVC filter insertion.MeasurementsOutcomes included the occurrence of complications (pulmonary embolism, deep vein thrombosis, and overall combined rates of complications by severity) within 30 days of bariatric surgery.ResultsThere were no significant differences in baseline characteristics among the 1,077 patients with IVC filters and in 1,077 matched control patients. Patients receiving IVC filters had higher rates of pulmonary embolism (0.84% vs 0.46%; odds ratio [OR], 2.0; 95% confidence interval [CI], 0.6-6.5; P=0.232), deep vein thrombosis (1.2% vs 0.37%; OR, 3.3; 95% CI, 1.1-10.1; P=0.039), venous thromboembolism (1.9% vs 0.74%; OR, 2.7; 95% CI, 1.1-6.3, P=0.027), serious complications (5.8% vs 3.8%; OR, 1.6; 95% CI, 1.0-2.4; P=0.031), permanently disabling complications (1.2% vs 0.37%; OR, 4.3; 95% CI, 1.2-15.6; P=0.028), and death (0.7% vs 0.09%; OR, 7.0; 95% CI, 0.9-57.3; P=0.068). Of the 7 deaths among patients with IVC filters, 4 were attributable to pulmonary embolism and 2 to IVC thrombosis/occlusion.ConclusionsWe have identified no benefits and significant risks to the use of prophylactic IVC filters among bariatric surgery patients and believe that their use should be discouraged.Copyright © 2013 Society of Hospital Medicine.

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