A quality improvement project to improve inferior vena cava filter retrieval

Todd E. Simon, Patrick F. Walker, Leo Daab, Joseph M. White, Paul W. White

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up a common cause. In 2009, we reported a retrieval rate of 18% despite an initial follow-up rate of 85%. Use of a registry has been shown to improve retrieval rates. As a quality improvement project, in May 2012, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We report the results in 125 patients after 38 months. Methods Patients receiving an R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record. When there was no longer an indication for the R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon followed by retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were collected. Results There were 125 R-IVCFs placed between May 2012 and June 2015; 52 filters were placed for therapeutic and 73 for prophylactic indications. Our follow-up rate improved to 94%. A total of 79 filters were retrieved (63% absolute retrieval rate). Excluding patients who died before retrieval and patients with a permanent indication, 77% of filters were retrieved. The average dwell time was 101.5 days (7-460 days), and 63% of successful R-IVCF retrievals were within 3 months of placement. Technical success for retrieval was 92%. There were two major complications from retrievals (1.5% of retrievals). Conclusions The creation of an R-IVCF registry promoted ongoing follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45% and increased our follow-up rate to 94%. These results emphasize the importance of repetitive follow-up for R-IVCFs. Despite a follow-up rate >90%, around a third of R-IVCFs were not retrieved.

Original languageEnglish (US)
Pages (from-to)42-46
Number of pages5
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Vena Cava Filters
Quality Improvement
Registries
Blood Vessels
Electronic Health Records
Appointments and Schedules
Outpatients
Demography

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

A quality improvement project to improve inferior vena cava filter retrieval. / Simon, Todd E.; Walker, Patrick F.; Daab, Leo; White, Joseph M.; White, Paul W.

In: Journal of Vascular Surgery: Venous and Lymphatic Disorders, Vol. 5, No. 1, 01.01.2017, p. 42-46.

Research output: Contribution to journalArticle

Simon, Todd E. ; Walker, Patrick F. ; Daab, Leo ; White, Joseph M. ; White, Paul W. / A quality improvement project to improve inferior vena cava filter retrieval. In: Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2017 ; Vol. 5, No. 1. pp. 42-46.
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title = "A quality improvement project to improve inferior vena cava filter retrieval",
abstract = "Objective Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up a common cause. In 2009, we reported a retrieval rate of 18{\%} despite an initial follow-up rate of 85{\%}. Use of a registry has been shown to improve retrieval rates. As a quality improvement project, in May 2012, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We report the results in 125 patients after 38 months. Methods Patients receiving an R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record. When there was no longer an indication for the R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon followed by retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were collected. Results There were 125 R-IVCFs placed between May 2012 and June 2015; 52 filters were placed for therapeutic and 73 for prophylactic indications. Our follow-up rate improved to 94{\%}. A total of 79 filters were retrieved (63{\%} absolute retrieval rate). Excluding patients who died before retrieval and patients with a permanent indication, 77{\%} of filters were retrieved. The average dwell time was 101.5 days (7-460 days), and 63{\%} of successful R-IVCF retrievals were within 3 months of placement. Technical success for retrieval was 92{\%}. There were two major complications from retrievals (1.5{\%} of retrievals). Conclusions The creation of an R-IVCF registry promoted ongoing follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45{\%} and increased our follow-up rate to 94{\%}. These results emphasize the importance of repetitive follow-up for R-IVCFs. Despite a follow-up rate >90{\%}, around a third of R-IVCFs were not retrieved.",
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AB - Objective Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up a common cause. In 2009, we reported a retrieval rate of 18% despite an initial follow-up rate of 85%. Use of a registry has been shown to improve retrieval rates. As a quality improvement project, in May 2012, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We report the results in 125 patients after 38 months. Methods Patients receiving an R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record. When there was no longer an indication for the R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon followed by retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were collected. Results There were 125 R-IVCFs placed between May 2012 and June 2015; 52 filters were placed for therapeutic and 73 for prophylactic indications. Our follow-up rate improved to 94%. A total of 79 filters were retrieved (63% absolute retrieval rate). Excluding patients who died before retrieval and patients with a permanent indication, 77% of filters were retrieved. The average dwell time was 101.5 days (7-460 days), and 63% of successful R-IVCF retrievals were within 3 months of placement. Technical success for retrieval was 92%. There were two major complications from retrievals (1.5% of retrievals). Conclusions The creation of an R-IVCF registry promoted ongoing follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45% and increased our follow-up rate to 94%. These results emphasize the importance of repetitive follow-up for R-IVCFs. Despite a follow-up rate >90%, around a third of R-IVCFs were not retrieved.

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