Hospital-level Variation in Inferior Vena Cava Filter Insertion in Trauma Patients: An Opportunity for a National Appropriateness Quality Improvement Initiative
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To evaluate inferior vena cava (IVC) filter utilization among trauma patients with regard to national trends, interhospital variation, and association with outcomes. BACKGROUND: 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. METHODS: We performed a study using American College of Surgeons Trauma Quality Improvement Program data from 2017 to 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 were evaluated using Pearson correlation coefficients. RESULTS: 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% to 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 venous thromboembolism ( r = 0.30; all P < 0.001). CONCLUSIONS: Although rates of IVC filter use in trauma patients have 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.
Source: Annals of Surgery
Institutions: University of Michigan, University of Washington
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7164993331