Kalina Michael, Bartley Marilyn, Cipolle Mark, Tinkoff Glen, Stevenson Scott, Fulda Gerard
Surgical and Critical Care Associates, Christiana Care Health System, 4735 Ogletown-Stanton Road, Newark, DE 19713, USA.
Am Surg. 2012 Jan;78(1):94-7. doi: 10.1177/000313481207800143.
The American Association for the Surgery of Trauma challenged the trauma community to improve a 22 per cent average removal rate for retrievable inferior vena cava filters (r-IVCFs). Since 2006, we maintained a "filter registry" documenting all IVCFs placed in trauma patients. Our goal was to improve removal rates for r-IVCF. Patients receiving an IVCF before implementation of filter registry, 2003-2005, comprised the control group. Patients receiving an IVCF after implementation of filter registry, 2006-2009, comprised the study group. Data obtained included age, gender, Injury Severity Score (ISS), length of stay (LOS), mortality, filter inserted, placement indication, removal rates, and reasons why removal did not occur. Fisher exact test and chi square were used for nominal variables. Stepwise logistic regression analysis was used to define predictors of removing and not removing an IVCF. Three hundred seven patients received an IVCF, 142 preregistry and 165 postregistry. No significant difference existed between groups in age, gender, ISS, placement indication, or mortality. A significant difference existed between groups in LOS and presence of deep vein thrombosis (DVT) and pulmonary embolism. A total of 98.2 per cent of postregistry patients received a Günther Tulip filter and all retrievals were performed by Interventional Radiology. Retrieval rates improved, 15.5 to 31.5 per cent post registry (P < 0.001). No differences existed in lost to follow-up (LTF) between groups. Univariate analysis identified age, IVC clot, DVT, and LTF as predictors for not removing a filter. Stepwise logistic regression revealed the filter registry independently predicts the removal of an r-IVCF. A filter registry is effective in improving rates of removal for r-IVCFs.
美国创伤外科学会向创伤学界发起挑战，要求将可取出的下腔静脉滤器（r-IVCF）的平均取出率提高22%。自2006年以来，我们维持了一个“滤器登记册”，记录所有植入创伤患者体内的IVCF。我们的目标是提高r-IVCF的取出率。在2003年至2005年滤器登记册实施之前接受IVCF的患者组成对照组。在2006年至2009年滤器登记册实施之后接受IVCF的患者组成研究组。获取的数据包括年龄、性别、损伤严重程度评分（ISS）、住院时间（LOS）、死亡率、植入的滤器、植入指征、取出率以及未取出的原因。费舍尔精确检验和卡方检验用于名义变量。逐步逻辑回归分析用于确定取出和未取出IVCF的预测因素。307例患者接受了IVCF，其中142例在登记之前，165例在登记之后。两组在年龄、性别、ISS、植入指征或死亡率方面无显著差异。两组在LOS以及深静脉血栓形成（DVT）和肺栓塞的存在方面存在显著差异。登记之后的患者中共有98.2%接受了Günther Tulip滤器，所有取出操作均由介入放射科进行。登记之后取出率有所提高，从15.5%提高到31.5%（P < 0.001）。两组在失访（LTF）方面无差异。单因素分析确定年龄、下腔静脉血栓、DVT和LTF为未取出滤器的预测因素。逐步逻辑回归显示滤器登记册可独立预测r-IVCF的取出。滤器登记册对于提高r-IVCF的取出率是有效的。
