Money well spent? A cost and utilization analysis of prophylactic inferior vena cava filter placement in high-risk trauma patients
| Autor: | Margo Nicole Carlin, Marko Bukur, Alireza Daneshpajouh, Joseph Catino |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Vena Cava Filters Inferior vena cava filter Vena Cava Inferior Medicare Inferior vena cava 03 medical and health sciences 0302 clinical medicine Injury Severity Score Trauma Centers Risk Factors Head Injuries Closed medicine Humans 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over business.industry Accidents Traffic Anticoagulants 030208 emergency & critical care medicine Middle Aged medicine.disease United States Surgery Pulmonary embolism medicine.vein Spinal Injuries Closed head injury Orthopedic surgery Chemoprophylaxis Cohort Costs and Cost Analysis Accidental Falls Female business Pulmonary Embolism |
| Zdroj: | The Journal of surgical research. 220 |
| ISSN: | 1095-8673 |
| Popis: | Background Inferior vena cava filters (IVCF) for venous thromboembolic prophylaxis in high-risk trauma patients is a controversial practice. Utilization of IVCF prophylaxis was evaluated at a level 1 trauma center. Daily cost of IVCF prophylaxis, time to IVCF, duration between IVCF and chemoprophylaxis, and number of patients needed to treat (NNT) to prevent pulmonary embolism (PE) was calculated. Methods A retrospective review of prophylactic IVCF over a 5-year period (2010-2014). Demographic, physiologic, injury, procedural, and outcome data were abstracted from the administrative trauma database. Medicare fees and days without chemoprophylaxis were used to determine daily IVCF cost. NNT was calculated using PE events in a cohort without IVCF. Results Over the 5-year period, 146 patients with mean age 56.3 y (SD ± 24.2), 67.8% male, underwent prophylactic IVCF. Predominant mechanisms of injuries were falls (45.9%) and motor vehicle accidents (20.5%) with median Injury Severity Score of 25 (intraquartile range [IQR] 16-29) and head Abbreviated Injury Score of 3 (IQR 3-5). Most common operative interventions required in 24.7% were orthopedic (25.3%) and neurosurgical (21.9%). Median time to IVCF was 78 h (IQR 48-144). Most common IVCF indications were closed head injury (48.6%) and spinal injuries (30.8%). Median time to administration of chemoprophylaxis was 96 h after IVCF (IQR 24-192) in 57.5%. Median IVCF cost was $759/d (IQR $361-$1897) compared with $4.32 for chemoprophylaxis. PE occurred in 0.26% without IVCF. PE did not occur with prophylactic IVCF. Estimated NNT was 379 (95% CI 265, 661). Conclusions Prophylactic IVCF placement is a costly practice with relatively low benefit. Anticipated time without chemoprophylaxis and patient criteria should be considered before routine IVCF placement. |
| Databáze: | OpenAIRE |
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