Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora.
JAMA Netw Open. 2023 Mar 1;6(3):e233211. doi: 10.1001/jamanetworkopen.2023.3211.
Inferior vena cava filters are commonly implanted and infrequently retrieved. Nonretrieval contributes to significant morbidity, motivating US Food and Drug Administration and multisociety communications emphasizing the need for improved device surveillance. Current guidelines suggest that implanting physicians and referring physicians should be responsible for device follow-up, but it is not known whether shared responsibility contributes to lower retrieval.
To determine if primary responsibility for follow-up care assumed by the implanting physician team is associated with increased device retrieval.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined a prospectively collected registry of patients with inferior vena cava filters implanted from June 2011 to September 2019. Medical record review and data analysis was completed in 2021. The study included 699 patients who underwent implantation of retrievable inferior vena cava filters at an academic quaternary care center.
Prior to 2016, implanting physicians had a passive surveillance strategy whereby letters highlighting indications for and the need for timely retrieval were mailed to patients and ordering clinicians. Starting in 2016, implanting physicians assumed active responsibility for surveillance, whereby candidacy for device retrieval was assessed periodically via phone calls and retrieval scheduled when appropriate.
The main outcome was the odds of inferior vena cava filter nonretrieval. Within regression modeling of the association between the surveillance method and nonretrieval, additional covariates of patient demographics, concomitant malignant neoplasm, and presence of thromboembolic disease were included.
Of the 699 patients who received retrievable filter implants, 386 (55.2%) were followed up with passive surveillance, 313 (44.8%) with active surveillance, 346 (49.5%) were female, 100 (14.3%) were Black individuals, and 502 (71.8%) were White individuals. The mean (SD) age at filter implantation was 57.1 (16.0) years. Mean (SD) yearly filter retrieval increased following the adoption of active surveillance, from 190 of 386 (48.7%) to 192 of 313 (61.3%) (P < .001). Fewer filters were deemed permanent in the active group vs passive group (5 of 313 [1.6%] vs 47 of 386 [12.2%]; P < .001). Age at the time of implantation (OR, 1.02; 95% CI, 1.01-1.03), concomitant malignant neoplasm (OR, 2.18; 95% CI, 1.47-3.24), and passive contact method (OR, 1.70; 95% CI, 1.18-2.47) were associated with increased odds of filter nonretrieval.
The findings of this cohort study suggest that active surveillance by implanting physicians is associated with improved inferior vena cava filter retrieval. These findings support encouraging physicians who implant the filter to take primary responsibility for tracking and retrieval.
下腔静脉滤器通常被植入，很少被取出。不取出会导致严重的发病率，这促使美国食品和药物管理局以及多个医学协会发出通告，强调需要改进设备监测。目前的指南建议植入医生和转诊医生应该负责设备的后续跟踪，但尚不清楚共同承担责任是否会提高取出率。
确定植入医生团队承担的后续护理主要责任是否与提高设备取出率有关。
设计、地点和参与者：这是一项回顾性队列研究，对 2011 年 6 月至 2019 年 9 月期间在学术四级保健中心植入下腔静脉滤器的患者进行了前瞻性收集登记。2021 年完成了病历回顾和数据分析。研究包括 699 名在学术四级保健中心接受可回收下腔静脉滤器植入的患者。
在 2016 年之前，植入医生采用被动监测策略，通过向患者和开医嘱的临床医生邮寄强调植入指征和及时取出必要性的信件来进行监测。从 2016 年开始，植入医生承担主动监测的责任，通过电话定期评估设备取出的适宜性，并安排取出。
主要结果是下腔静脉滤器未取出的几率。在监测方法与未取出之间的关联的回归模型中，纳入了患者人口统计学、伴随恶性肿瘤和血栓栓塞性疾病存在的额外协变量。
在接受可回收滤器植入的 699 名患者中，386 名（55.2%）接受了被动监测，313 名（44.8%）接受了主动监测，346 名（49.5%）为女性，100 名（14.3%）为黑人，502 名（71.8%）为白人。植入滤器时的平均（SD）年龄为 57.1（16.0）岁。自采用主动监测以来，每年滤器取出量增加，从 386 名患者中的 190 名（48.7%）增加到 313 名患者中的 192 名（61.3%）（P<0.001）。主动组比被动组中更多的滤器被认为是永久性的（主动组 5 例[1.6%]，被动组 47 例[12.2%]；P<0.001）。植入时的年龄（比值比，1.02；95%置信区间，1.01-1.03）、伴随恶性肿瘤（比值比，2.18；95%置信区间，1.47-3.24）和被动接触方法（比值比，1.70；95%置信区间，1.18-2.47）与滤器未取出的几率增加相关。
这项队列研究的结果表明，植入医生的主动监测与提高下腔静脉滤器取出率有关。这些发现支持鼓励植入滤器的医生承担起跟踪和取出的主要责任。
