Hospital-Level Variation in IVC Filter Insertion in Trauma Patients: An Opportunity for a National Appropriateness Quality Improvement Initiative.

Abstract

To evaluate inferior vena cava (IVC) filter utilization among trauma patients with regard to national trends, interhospital variation, and association with outcomes. IVC filters can be placed for therapeutic or prophylactic indications. Current clinical guidelines recommend IVC filter placement only for trauma patients with a proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) and contraindication to anticoagulation. We performed a study using American College of Surgeons Trauma Quality Improvement Program data from 2017-2024. Inclusion criteria were adult patients, admitted to a Level I or II trauma center, with blunt or penetrating injury, hospital length of stay ≥3 days, and an Injury Severity Score ≥9. Hospital-level IVC filter insertion rates were calculated, and trauma centers were classified as low (<1%) or high (≥1%) utilizers. Risk-adjusted hospital-level outcomes were generated using mixed-effects logistic regression with empirical Bayes shrinkage. Associations between hospital-level IVC filter utilization and mortality, DVT, PE, and venous thromboembolism (VTE) were evaluated using Pearson correlation coefficients. Among 2,277,066 patients, at 427 trauma centers, 18,415 (0.81%) underwent IVC filter placement. Utilization declined from 1.15% in 2017 to 0.59% in 2024 (P<0.001). Substantial interhospital variation was found, with 96 trauma centers (22.5%) demonstrating rates of IVC filter insertion ≥1% (range, 0%-11.5%). Higher hospital-level IVC filter use was not associated with risk-adjusted in-hospital mortality (r=0.01, P=0.77) but was associated with increased rates of DVT (r=0.28), PE (r=0.20), and VTE (r=0.30) (all P<0.001). Although rates of IVC filter use in trauma patients has declined, marked interhospital variation exists. A higher rate of IVC filter utilization was not associated with improved survival. This suggests an opportunity to measure and optimize appropriate IVC filter use across trauma centers.