Charlton-Ouw Kristofer M, Leake Samuel S, Sola Cristina N, Sandhu Harleen K, Albarado Rondel, Holcomb John B, Miller Charles C, Safi Hazim J, Azizzadeh Ali
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Memorial Hermann Hospital, Texas Medical Center, Houston, TX.
Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
Ann Vasc Surg. 2015 Jan;29(1):84-9. doi: 10.1016/j.avsg.2014.05.018. Epub 2014 Jun 12.
Considering new guidelines for retrievable inferior vena cava filters (IVCFs), we examine our initial experience after establishing a comprehensive filter removal program in our level 1 trauma center. We evaluated the technical and financial feasibility of this program and barriers to IVCF retrieval, including insurance status and costs, in trauma patients.
Trauma patients receiving IVCFs from May 2011 to 2013 were consented and prospectively enrolled in the study program. Retrieval rates were assessed for the years before study initiation. Primary outcome was IVCF retrieval. Hospital financial data for retrieval were examined and univariate analysis performed. Hospital cost-to-charge and payment-to-charge ratios were assessed.
Before study initiation from April 2009 to 2011, 66 IVCFs were placed in trauma patients with only 2 retrievals in 2 years. During the study period, 247 trauma patients had IVCF placement of which 111 (45%) were enrolled. The main reason for nonenrollment was lack of referral by the implanting team. Retrieval was attempted in 100 outpatients with success in 85 (85%). Patients enrolled in the program were more likely to have their filters removed (73% vs. 18%; odds ratio, 12.6; 95% confidence interval, 6.6-24.3; P < 0.001). Mean time from placement to attempt was 6.2 ± 4.0 months (range, 0.5-31.8). Of the total attempts, 29% were nonresource patients, 11% had Medicaid, and 60% had commercial insurance including Medicare patients. Chances of successful retrieval were higher if performed later during the study (P = 0.03). Successful retrieval was not related to insurance status (P = not significant). The mean total hospital charges related to retrieval were $4,493 (range, $2,510-$9,106). Successful retrieval contributed to lower total charges (P < 0.01). Factors contributing to higher total charges were retrieval attempt later in study period (P = 0.01) and commercial insurance status (P = 0.04).
The rate of IVCF placement in trauma patients increased 4-fold over 4 years. The rate of IVCF retrieval increased more than 14-fold during the same period after establishment of the retrieval program. Elective outpatient retrieval of IVCFs in all eligible trauma patients is financially feasible without loss to the health care system even in regions with high rates of uninsured. A major barrier to successful filter retrieval was lack of patient referral into the program by implanting physicians. Hospital administration and physician outreach are important determinants of successful IVCF retrieval in trauma patients.
鉴于可回收下腔静脉滤器（IVCF）的新指南，我们在一级创伤中心建立全面的滤器取出计划后，审视了我们的初步经验。我们评估了该计划在技术和财务方面的可行性，以及创伤患者IVCF取出的障碍，包括保险状况和费用。
2011年5月至2013年接受IVCF的创伤患者签署知情同意书并前瞻性纳入研究计划。评估研究开始前数年的取出率。主要结局是IVCF取出。检查取出的医院财务数据并进行单因素分析。评估医院成本与收费比率以及支付与收费比率。
在2009年4月至2011年研究开始前，66例创伤患者植入了IVCF，两年内仅2例取出。在研究期间，247例创伤患者植入了IVCF，其中111例（45%）纳入研究。未纳入的主要原因是植入团队未转诊。对100例门诊患者尝试取出，85例（85%）成功。纳入该计划的患者更有可能取出滤器（73%对18%；优势比，12.6；95%置信区间，6.6 - 24.3；P < 0.001）。从植入到尝试取出的平均时间为6.2±4.0个月（范围，0.5 - 31.8个月）。在所有尝试取出中，29%为无保险患者，11%有医疗补助，60%有商业保险，包括医疗保险患者。如果在研究后期进行取出，成功的机会更高（P = 0.03）。成功取出与保险状况无关（P = 无显著性）。与取出相关的平均医院总收费为4493美元（范围，2510 - 9106美元）。成功取出导致总收费降低（P < 0.01）。导致总收费较高的因素是在研究后期尝试取出（P = 0.01）和商业保险状况（P = 0.04）。
创伤患者IVCF植入率在4年内增加了4倍。在建立取出计划后的同一时期，IVCF取出率增加了超过14倍。即使在未参保率高的地区，对所有符合条件的创伤患者进行择期门诊IVCF取出在财务上是可行的，且不会给医疗保健系统造成损失。成功取出滤器的一个主要障碍是植入医生未将患者转诊至该计划。医院管理和医生宣传是创伤患者成功取出IVCF的重要决定因素。
