Department of Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
Division of Health Care Delivery Research, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
Langenbecks Arch Surg. 2022 Sep;407(6):2327-2335. doi: 10.1007/s00423-022-02532-6. Epub 2022 May 27.
Metabolic and bariatric surgery (MBS) remains a safe and effective treatment for morbid obesity with a low-risk profile. Venous thromboembolism (VTE) remains the most common cause of mortality. There is increasing consensus that inferior vena cava (IVC) filter use is associated with more harm than benefit. Our study aim was to determine if the timing of IVC filter placement correlates with VTE complications.
The 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases were used to identify Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) patients who had an IVC filter at the time of bariatric procedure. Selected cases were stratified by IVC placement timing. Propensity-score matching estimated the probabilities of receiving pre-existing vs. prophylactic IVC placement. Resultant models were then used to assess VTE complications. Statistical analyses were performed with Stata MP version 16. A p-value < 0.05 was considered significant.
In total, 228,986 RYGB and 568,386 SG cases were analyzed, and 0.6% and 0.5% had an IVC filter. Prophylactic IVC filter use declined annually, but not pre-existing filters. VTE and VTE-related mortality were significantly higher in filter vs. no filter cohorts (p<0.001). Propensity matching reduced biases between RYGB and SG IVC filter cohorts (pre-existing vs. prophylactic). There were no differences in the RYGB pre-existing and prophylactic IVC filter cohorts; however; for SG cases, pre-existing IVC filters compared to prophylactic IVC filters were associated with decreased odds of having a VTE (OR: 0.97, 95% CI: 0.95, 0.99).
Compared to a pre-existing filter, the presence of a prophylactic IVC filter in SG patients was associated with a higher likelihood of VTE.
代谢和减重手术（MBS）仍然是一种安全有效的治疗病态肥胖的方法，其风险低。静脉血栓栓塞（VTE）仍然是最常见的死亡原因。越来越多的共识认为，下腔静脉（IVC）滤器的使用弊大于利。我们的研究目的是确定 IVC 滤器放置的时间是否与 VTE 并发症相关。
使用 2015-2019 年代谢和减重手术认证和质量改进计划数据库，确定在减重手术时放置 IVC 滤器的 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG）患者。选择的病例按 IVC 放置时间分层。倾向评分匹配估计接受预先存在的与预防性 IVC 放置的概率。然后使用所得模型评估 VTE 并发症。使用 Stata MP 版本 16 进行统计分析。p 值<0.05 被认为具有统计学意义。
共分析了 228986 例 RYGB 和 568386 例 SG 病例，0.6%和 0.5%的患者有 IVC 滤器。预防性 IVC 滤器的使用逐年下降，但预先存在的滤器没有。与无滤器组相比，滤器组的 VTE 和 VTE 相关死亡率明显更高（p<0.001）。倾向匹配降低了 RYGB 和 SG IVC 滤器组之间的偏倚（预先存在的与预防性）。RYGB 预先存在和预防性 IVC 滤器组之间没有差异；然而，对于 SG 病例，与预防性 IVC 滤器相比，预先存在的 IVC 滤器与 VTE 发生的可能性降低有关（OR：0.97，95%CI：0.95，0.99）。
与预先存在的滤器相比，SG 患者预防性 IVC 滤器的存在与 VTE 的可能性增加相关。
