Clinical outcomes of orthopaedic surgery patients with inferior vena cava filter prophylaxis

Orthopaedic surgery patients are at an elevated risk of venous thromboembolic events thus necessitating effective prophylaxis strategies.

This IRB-approved, single-center retrospective study evaluated patients who underwent orthopaedic surgery and were protected with Inferior Vena Cava (IVC) filters from January 2007 to December 2021. Study outcomes include incidence of venous thromboembolism (VTE) in the form of deep vein thrombosis (DVT) and pulmonary embolism (PE), and filter-related complications.

A total of 104 patients (median age 57 years, range: 18 - 78; 53% women) who underwent orthopaedic surgery were protected against PE with IVC filters. This cohort was surgically diverse with 50 patients (48%) having underwent arthroplasty, 17 (16%) underwent amputations, disarticulations, and hemipelvectomies, 16 (15%) had resections and 16 (15%) had open reduction and internal fixations (ORIF), three patients (3%) underwent incision and drainages (I&D), and two patients (2%) had complex multi-operational surgeries. Patients were high-risk given the large burden of comorbidities, including low functional status (88%), VTE history (62%), malignancy (57%), and history of tobacco use (47%). All filters were placed without complication. A majority of filters were retrieved (58%; n = 60), with an average dwell time of 6.7 months (1-31 months). In the post-placement period, 16 patients (15%) experienced DVTs with four patients (4%) experiencing PEs. There were three removal attempts that encountered difficulty, leading to aborted attempts of which two were later successful.

IVC filters were placed and retrieved in orthopaedic patients with a low complication rate while achieving a low incidence of VTE in this high-risk cohort.