Hospital-Level Variation in IVC Filter Insertion in Trauma Patients

OBJECTIVE: To evaluate inferior vena cava (IVC) filter utilization among trauma patients with regard to national trends, interhospital variation, and association with outcomes. SUMMARY BACKGROUND DATA: IVC filters can be placed for therapeutic or prophylactic indications. Current clinical guidelines recommend IVC filter placement only for trauma patients with a proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) and contraindication to anticoagulation. METHODS: We performed a study using American College of Surgeons Trauma Quality Improvement Program data from 2017-2024. Inclusion criteria were adult patients, admitted to a Level I or II trauma center, with blunt or penetrating injury, hospital length of stay ≥3 days, and an Injury Severity Score ≥9. Hospital-level IVC filter insertion rates were calculated, and trauma centers were classified as low (<1%) or high (≥1%) utilizers. Risk-adjusted hospital-level outcomes were generated using mixed-effects logistic regression with empirical Bayes shrinkage. Associations between hospital-level IVC filter utilization and mortality, DVT, PE, and venous thromboembolism (VTE) were evaluated using Pearson correlation coefficients. RESULTS: Among 2,277,066 patients, at 427 trauma centers, 18,415 (0.81%) underwent IVC filter placement. Utilization declined from 1.15% in 2017 to 0.59% in 2024 (P<0.001). Substantial interhospital variation was found, with 96 trauma centers (22.5%) demonstrating rates of IVC filter insertion ≥1% (range, 0%-11.5%). Higher hospital-level IVC filter use was not associated with risk-adjusted in-hospital mortality (r=0.01, P=0.77) but was associated with increased rates of DVT (r=0.28), PE (r=0.20), and VTE (r=0.30) (all P<0.001). CONCLUSIONS: Although rates of IVC filter use in trauma patients has declined, marked interhospital variation exists. A higher rate of IVC filter utilization was not associated with improved survival. This suggests an opportunity to measure and optimize appropriate IVC filter use across trauma centers.