Pulmonary Procedures |

Cost Effectiveness and Procedural Complications of Bedside Inferior Vena Cava Filter Placement in Intensive Care Unit Versus Conventional Fluoroscopy: Results From a Pooled Analysis FREE TO VIEW

Prasanna Sengodan, MD; Qi Zhang, MS; Narendrakumar Alappan, MD
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Cleveland Clinic at Fairview Hospital, Westlake, OH

Chest. 2015;148(4_MeetingAbstracts):815A. doi:10.1378/chest.2229724
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SESSION TITLE: Interventional Pulmonology Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To compare the cost effectiveness and procedural complications of bedside inferior vena cava filter (IVCF) placement in ICU setting versus conventional fluoroscopy methods. Ultrasound techniques ha been used to assist with bedside IVCF placement since late 1990’s with good success. Despite ease of bedside IVC filter placement, it’s use has been limited. No randomized controlled trials are available to assess the superiority of one approach versus the other.

METHODS: All published reports including prospective, retrospective studies and case series between 1995 and 2014 were identified using an electronic search and pooled to create a sample of patient data for statistical analysis. Paired t-test was applied for the cost effective analysis. Chi-square test and fisher’s exact test were applied for the analysis of technical success and procedural complications rates, respectively.

RESULTS: We identified 11 studies that included a total of 967 patients who underwent bedside IVCF placement and 416 patients who underwent IVCF by fluoroscopy. The average costs for bedside and fluoroscopy methods were [Mean (SD)] of $2681.2 (624.5) and $3901.7 (405.3) respectively with P value 0.0010. Fluoroscopy IVC had higher technical success rate than bedside IVCF placement (100% (416) versus 97.4% (942) P value <0.001), similarly Fluoroscopy IVC also has lower minor complication rate than bedside IVCF placement [0.9% (4) versus 5.2% (51) P value < 0.001).

CONCLUSIONS: We conclude with limitations that fluoroscopy techniques have better technical success rate and minimal complication rate. But bedside IVC filter in the ICU had significant cost savings compared to fluoroscopy. The limitations of our study include the imbalance in the number of patients in both arms. Also the information on the variances of the costs is lacking, as the studies have not reported them, so limited inference can be drawn about the cost effectiveness, although it is statistically significant.

CLINICAL IMPLICATIONS: Although IVCF placement by fluoroscopy appears better, the complications and technical success rates in the bedside arm are quite reasonable, considering the potential advantages. Studies have shown that bedside insertion of IVCF in the ICU is a safe procedure with minimal complications, especially in the critically ill, requiring ionotropic and ventilator support, where mobilization to the fluroscopy suite could be risky. Randomized controlled trials are needed to establish definitive efficacy and safety of one technique over the other.

DISCLOSURE: The following authors have nothing to disclose: Prasanna Sengodan, Qi Zhang, Narendrakumar Alappan

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