Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA.
Surgery. 2013 May;153(5):683-8. doi: 10.1016/j.surg.2012.11.005. Epub 2013 Jan 7.
Geographic variability exists in the use of IVC filters (IVCF). We hypothesized that variation in IVCF use is incompletely explained by variation in the prevalence of deep-vein thrombosis (DVT) and pulmonary embolism (PE) and may result from different practice patterns regarding prophylactic IVCF use. We characterize geographic variation in IVCF use at the state level and evaluate its association with clinical factors, patient demographics, and the medicolegal environment.
Healthcare Cost and Utilization Project State Inpatient Database records were accessed to identify 230,445 IVCFs placed from 2006 to 2008 in 33 states. Similar queries were performed for DVT and PE. Additional state data were obtained from public sources. Analyses included descriptive statistics, Spearman Correlation (SC), Wilcoxon rank-sum test, and characterization of variability.
Overall, IVCF use correlated with the prevalence of DVT (SC = 0.89, P < .01). States on the East coast have significantly greater rates of IVCF use per 100K (mean ± SD = 41.2 ± 16.7 vs 27.8 ± 11.1, P < .05) and greater rates of IVCF per DVT (20.2 ± 4.5% vs 15.2 ± 2.9%; P < .005), despite similar rates of DVT per 100K (198.1 ± 51.2 vs 177.7 ± 46.7, P = NS) compared with all other states. Overall, states with the greatest rate of IVCF per DVT were (in descending order): Rhode Island, New Jersey, Florida, New York, and West Virginia. Rates of detected PE per 100K in these states were not significantly different from all other states (95.6 ± 16.6 vs 90.4 ± 16.1, P = NS). In these states, a greater percentage of IVCF recipients were older than 85 (15.3% vs 11.8%; P < .01); fewer were pediatric (0.3% vs 0.7%; P < .05) or aged 45 to 64 (26.1% vs 32.4%; P < .001). There were no differences in patient sex, race, insurance type, hospital size, or teaching status. States with high rates of IVCF per DVT were noted to have significantly greater rates of paid malpractice claims per 100K (4.9 ± 2.51 vs 1.1 ± 0.8; P = .001), and annual general surgeon liability insurance premiums ($78,630 ± 34,822 vs $43,989 ± 17,794; P < .05).
Variation in IVCF use is incompletely explained by clinical factors. High rates of IVCF per DVT in some states may represent increased use of prophylactic IVCF in states with litigious medicolegal environments.
静脉滤器（IVCF）的使用存在地域差异。我们假设，IVCF 使用的变化不能完全用深静脉血栓形成（DVT）和肺栓塞（PE）的流行率变化来解释，可能是由于预防使用 IVCF 的不同实践模式造成的。我们对州级别的 IVCF 使用情况进行了地域差异描述，并评估了其与临床因素、患者人口统计学特征和法医学环境的关联。
访问医疗保健成本和利用项目州住院患者数据库记录，以确定 2006 年至 2008 年在 33 个州中放置的 230445 个 IVCF。对 DVT 和 PE 进行了类似的查询。从公共资源中获得了额外的州数据。分析包括描述性统计、斯皮尔曼相关系数（SC）、威尔科克森秩和检验和变异性描述。
总体而言，IVCF 使用与 DVT 的流行率相关（SC = 0.89，P <.01）。东海岸各州每 10 万的 IVCF 使用量明显更高（平均值 ± SD = 41.2 ± 16.7 与 27.8 ± 11.1，P <.05），每 DVT 的 IVCF 使用量也更高（20.2 ± 4.5% 与 15.2 ± 2.9%；P <.005），尽管每 10 万 DVT 的 DVT 发生率相似（198.1 ± 51.2 与 177.7 ± 46.7，P = NS）与所有其他州相比。总体而言，每 DVT 的 IVCF 使用量最大的州（按降序排列）：罗德岛、新泽西州、佛罗里达州、纽约州和西弗吉尼亚州。这些州的每 10 万检测到的 PE 率与所有其他州没有显著差异（95.6 ± 16.6 与 90.4 ± 16.1，P = NS）。在这些州，接受 IVCF 治疗的患者中，年龄大于 85 岁的比例更高（15.3% 与 11.8%；P <.01）；儿科患者比例较低（0.3% 与 0.7%；P <.05）或年龄在 45 至 64 岁的患者比例较低（26.1% 与 32.4%；P <.001）。患者性别、种族、保险类型、医院规模或教学地位没有差异。发现 IVCF 每 DVT 使用量较高的州，每 10 万的支付医疗事故索赔率明显较高（4.9 ± 2.51 与 1.1 ± 0.8；P =.001），每年普外科责任保险费也较高（78630 美元 ± 34822 美元与 43989 美元 ± 17794 美元；P <.05）。
IVCF 使用的变化不能完全用临床因素来解释。一些州中每 DVT 的 IVCF 使用量较高，可能反映了在法医学环境较易引发诉讼的州中预防性使用 IVCF 的增加。
