Back to 2026 Abstracts
Hospital-Level Variation in IVC Filter Insertion in Trauma Patients Reveals an Opportunity for a National Appropriateness Quality Improvement Initiative
*Cody L. Mullens1, *Anne Cain-Nielsen
1, *Scott Levy
1, *Jamila Picart
1, *Elizabeth Alore
1, *John Scott
2, Lena Napolitano
1, Mark Hemmila
11Department of Surgery, University of Michigan, Ann Arbor, Michigan; 2Department of Surgery, University of Washington, Seattle, Washington
Objective: Trauma patients are at elevated risk for life-threatening venous thromboembolic events (VTE). However, prophylactic inferior vena cava (IVC) filter placement is rarely indicated in trauma patients. Current clinical guidelines recommend IVC filter placement for patients with proximal deep vein thrombosis (DVT) or pulmonary embolism and contraindication to anticoagulation. A state-based trauma collaborative has been able to reduce IVC filter use to <1% of admitted trauma patients at participating hospitals. Given the risk of potential harm associated with IVC filter placement and no demonstrated mortality benefit, we sought to evaluate IVC filter use and clinical outcomes in hospitals participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP).
Methods: Using ACS TQIP participant use files from 2017-2023, we identified adult patients (≥18 years) with blunt or penetrating injury admitted to Level I or II trauma centers who met ACS TQIP database inclusion criteria. Patients who potentially transferred in after first being admitted to another hospital or had a length of stay <3 days were excluded. Hospitals were excluded if they did not admit patients in all years of the study. We calculated annual IVC filter placement rates for all patients. Mean annual facility-level IVC filter placement rates and interfacility variation were analyzed. To evaluate outcomes associated with the rate of IVC filter insertion, we generated risk-adjusted outcomes using mixed-effects logistic regression models accounting for patient and injury characteristics with facility-level random effects. We then examined the correlation between facility-specific risk-adjusted outcome rates and facility IVC filter insertion rates using linear regression.
Results: Among 1,950,909 trauma admissions across 430 trauma centers, 16,545 (.85%) patients underwent IVC filter insertion. Annual IVC filter use declined from 1.16% in 2017 to 0.62% in 2023 (p<.001). Despite this decline over time, a ten-fold variation in mean interhospital rates of IVC filter use was found (0-11.5%, Blue-dot = mean, Blue-line = 95% CI, Figure A.). The mean annual volume of ACS TQIP eligible patients at each trauma center is illustrated by green diamonds in Figure A. 103 (24%) trauma centers had mean rates of IVC filter use exceeding a 1% threshold of patients. Trauma centers with higher rates of IVC filter insertion had significantly higher risk-adjusted rates of DVT (p<.001, Figure B.). However, there was no association of IVC filter usage at the hospital level with risk-adjusted mortality (p=.76)
Conclusion: One quarter of trauma centers participating in ACS TQIP utilize IVC filters at a rate >1% with no demonstrated outcome benefits for patients at a population level. These findings identify a clear and actionable target for a national trauma quality improvement initiative focused on appropriateness of IVC filter insertion in trauma patients at the hospital level.
IVC filter use rates by facility with annual trauma admission volume (A). Association between IVC filter rate and DVT (B)
Back to 2026 Abstracts
