M. A. Hornick1, E. K. Lai1, N. N. Williams1, P. J. Foley1, G. J. Wang1, K. R. Dumon1, S. E. Raper1, E. Y. Woo2, R. M. Fairman1, B. M. Jackson1 1Hospital Of The University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 2MedStar Health,Department Of Surgery,Washington, DISTRICT OF COLUMBIA, USA
Introduction: The benefit of prophylactic retrievable inferior vena cava filter (prIVCF) placement prior to bariatric surgery is uncertain. While indications for prIVCF in bariatric surgery patients remain somewhat ambiguous, filters are not infrequently placed in patients deemed relatively high risk for perioperative venous thromboembolism (pVTE) on the basis of body mass index (BMI), functional status, prior history of VTE, or other factors. In this single-institution retrospective review of bariatric surgery patient outcomes, we hypothesized that patients receiving prophylactic IVC filters, despite presumably higher risk for pVTE, ultimately have comparable outcomes to lower-risk patients who do not receive prIVCF.
Methods: We reviewed a single academic bariatric center experience from September 2002 to December 2011. Prophylactic IVC filters were placed in patients perceived to be high risk for pVTE according to an institutional protocol and surgeon judgment. Electronic medical records were reviewed retrospectively, and examined outcomes included perioperative (30-day) deep venous thromboembolism (DVT), pulmonary embolism (PE), and mortality. All statistical comparisons were made by χ2 test, Fisher exact test, or Student’s t-test as appropriate.
Results: 520 patients underwent prIVCF, and 1984 patients did not undergo prIVCF. The majority of patients in both the prIVCF and no prIVCF groups underwent laparoscopic gastric bypass (64.6% and 72.3%, respectively). Patients in the prIVCF group underwent laparoscopic sleeve gastrectomy at a proportionally higher rate (12.1% vs. 3.2%, P<0.0001). Patients in the prIVCF group had higher BMI (57.6+9.8 vs. 48.0±7.1, P<0.0001) and higher rate of prior DVT (8.8% vs. 0.6%, P<0.0001). Rate of perioperative DVT was significantly higher in the prIVCF group (2.3% vs. 0.9%, P=0.02). Rates of perioperative PE (0.8% vs. 0.7%, P=0.80) and perioperative mortality (0.2% vs. 0.1%, P=0.11) were not statistically different between prIVCF and no prIVCF groups.
Conclusion: Although indications for prIVCF in bariatric surgery patients are not well-defined, it is likely that patients referred for prIVCF are at higher risk for pVTE. In this large single-institution experience, bariatric patients receiving prIVCF had significantly higher BMI, higher rate of prior DVT, and ultimately higher rate of perioperative DVT than patients not receiving prIVCF. Despite these risk factors for pVTE, bariatric patients receiving prIVCF had comparable outcomes to patients not receiving prIVCF with respect to perioperative PE and mortality. These results suggest that prIVCF placement may confer substantial benefit in high-risk bariatric surgery patients.