Facility-Level Variation Underlying Low Inferior Vena Cava Filter Retrieval in the United States.

Abstract

Timely retrieval of inferior vena cava (IVC) filters is recommended to reduce complications and optimize outcomes. This study aims to quantify facility-level variation in risk-adjusted IVC filter retrieval across US hospitals and to identify patient- and hospital-level factors associated with nonretrieval. Medicare beneficiaries undergoing IVC filter implantation were identified in the 100% claims files for years 2016 to 2020. Facility-level variation in device retrieval was quantified using Bayesian hospital profiling. Patient- and hospital-level factors associated with nonretrieval were assessed using logistic regression, adjusting for diagnostic indication, comorbidities, and implantation year. IVC filters were implanted in 119,613 Medicare beneficiaries across 2,485 facilities. Retrieval rates were low: median 6.2% within 3 months and 14.8% within 1 year. Excluding deaths within 3 months (30.2%), retrieval ranged from 0% to 100% across facilities. Among high-volume hospitals (top 25th percentile, implanting ≥13 filters per year), 1-year risk-adjusted retrieval ranged from 0% to 74.5%, mean 20% ± 14.2% (positive skew 0.95). Patient factors associated with IVC filter nonretrieval included age > 80 years (odds ratio 2.98, 95% confidence interval [2.73-3.24]), Black race (1.62, [1.51-1.72]), and Hispanic ethnicity (1.45, [1.16-1.80]). Among hospital factors, nonteaching (1.45 [1.37-1.53]), small bed size (1.37 [1.24-1.50]), and safety-net (1.42 [1.34-1.50]) facilities were strongly associated with IVC filter nonretrieval. High mortality within 3 months of IVC filter implantation suggests opportunity to improve patient selection and, potentially, device type choice. There is large facility-level variance underlying low aggregate IVC filter retrieval nationally; a focus on standardizing device surveillance and identifying best practices from high-performing facilities is warranted.