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Vena cava filter use may vary widely between hospitals
The use of vena cava filters in patients with acute venous thromboembolism varied widely in California hospitals, not only according to clinical indications but also after adjusting for important confounders such as the hospital size, rural location and type of hospital.
Richard H. White, MD, and fellow researchers at UC Davis conducted a retrospective observational study of California hospital discharge data and determined the frequency of vena cava filter (VCF) use among patients admitted to California hospitals for venous thromboembolism (VTE) from 2006 to 2010.
There were 130,643 hospitalizations for acute VTE and 19,537 VCFs (14.95%) placed among the 263 hospitals that admitted more than 55 acute VTE patients during this time period. A wide variation was observed in the use of VCFs between hospitals, varying from 0% to 38.96% (interquartile range, 6.23%-18.14%). Differences among the hospitals accounted for 18.49% of the reported variation in frequency of VCF use.
Clinical predictors of VCF use included acute bleeding at the time of admission (OR=3.4; 95% CI, 3.2-3.6), a major operation after admission for VTE (OR=3.4; 95% CI, 3.3-3.5), presence of metastatic cancer (OR=1.7; 95% CI, 1.6-1.8) and extreme severity of illness (OR=2.5; 95% CI, 2.3-2.7 vs. mild illness).
VCFs were used more frequently than expected (average use) in 109 hospitals and less frequently in 59, with wide variations observed even in hospitals located close together. Hospital characteristics associated with VCF use included those with fewer beds (OR=0.2; 95% CI, 0.2-0.4, <100 beds vs. >400 beds), rural facilities (OR=0.4; 95% CI, 0.2-0.5) and other private facilities vs. Kaiser Permanente hospitals (OR=1.5; 95% CI, 1.1-2.0), which presumably reflect the absence or paucity of trained interventional radiologists or vascular surgeons, White and colleagues wrote.
Richard H. White
Local culture and practice pattern within each hospital are major reasons that account for the use of VCFs, they noted.
“The enthusiasm of specific physician-leaders within each hospital who advocate for or against the use of VCFs probably plays a central role in explaining the variation in VCF use across hospitals,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.
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