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Prophylactic inferior vena cava filters for operative pelvic fractures: a twelve year experience

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Abstract

Introduction

Conflicting evidence exists regarding the role of inferior vena cava filters (IVCFs) in the prevention of pulmonary embolism. The aim of this study was to review an institutional policy of prophylactic IVCF placement in all operative pelvic and acetabular fractures as a means of preventing PE by comparing it to a historical prepolicy period of significantly less aggressive IVCF placement.

Methods

The trauma registry of a single level 1 trauma center was retrospectively queried for all pelvic or acetabular fractures for the prepolicy and intervention periods as defined as January 2003–December 2008 and January 2009–December 2014, respectively—yielding 231 patients for analysis. The primary and secondary outcomes measured were the incidence of PE and deep vein thrombosis.

Results

The rate of prophylactic IVCF insertion significantly increased during the study period (p < 0.001). The incidence of pulmonary embolism (1.8% vs. 5.1%, p = 0.351) and DVT (19.3% vs. 10.3%, p = 0.231) were not significantly different when comparing the prepolicy and intervention cohorts. In patients with operative fractures, a nonsignificant trend of increasing incidence of DVTs was appreciated in patients with a prophylactic IVCF versus those without prophylactic IVCF (13 vs. 2, p = 0.222).

Discussion

A policy of increased use of prophylactic IVCFs in patients with operative pelvic and acetabular fractures failed to reduce the incidence of PE or DVT. In contrast, several case reports and institutional series have published several risks associated with IVCF placement including failure to retrieve temporary IVCF.

Conclusion

The benefit of prophylactic IVCF in this patient population is unclear.

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Acknowledgments

We would like to recognize Kathleen Maguire MD, Daniel Spielman BA, Jimmy Chan MD, and Dordaneh Sugano BS for their assistance in data collection for this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, PO Box 016960 (D27), Miami, FL, 33101, USA

    Wayne B. Cohen-Levy

  2. Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA

    Jin Liu

  3. Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA

    Milan Sen, Sheldon H. Teperman & Melvin E. Stone Jr.

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  1. Wayne B. Cohen-Levy
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Correspondence to Wayne B. Cohen-Levy.

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Institutional Review Board approval was obtained from the Albert Einstein College of Medicine prior to conducting the study.

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Cohen-Levy, W.B., Liu, J., Sen, M. et al. Prophylactic inferior vena cava filters for operative pelvic fractures: a twelve year experience. International Orthopaedics (SICOT) 43, 2831–2838 (2019). https://doi.org/10.1007/s00264-019-04384-0

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