Background

The 2013 ASMBS position statement on venous thromboembolism (VTE) in patients undergoing bariatric surgery states that inferior vena cava filter (IVCF) placement may be considered for select high-risk patients. Prior VTE may render a patient high-risk, yet data regarding the use of IVCF in this patient population and associated outcomes are lacking.

Methods

We queried the MBSAQIP database for all patients undergoing primary sleeve gastrectomy (CPT 43775) or Roux-en-Y gastric bypass (CPT 43644) from 2015 to 2019 with a history of VTE. We tabulated yearly IVCF use and compared 30-day rates of deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality in patients with and without prophylactic IVCF placement in anticipation of bariatric surgery.

Results

Of 754,397 patients undergoing bariatric surgery, 16,683 patients (2.2%) had a prior VTE. Placement of IVCF in these patients in anticipation of bariatric surgery decreased from 285/2245 cases (10.4%) in 2015 to 85/3750 cases (2.2%) in 2019 (p<0.01). The incidence of PE in patients with prophylactic IVCF was 0.1% compared to 0.5% in those without (p=0.13). Postoperative DVT was more common in patients who underwent IVCF placement (1.7% vs. 0.8%, p<0.01). No significant differences were observed in either bleeding complications or in-hospital and 30-day mortality.

Conclusions

The use of prophylactic IVCF placement in patients with a prior VTE has decreased. Placement of IVCF in this patient population is associated with a higher rate of DVT and similar mortality rates. The rate of PE, although lower in patients with IVCF, did not reach statistical significance.