Payer status is associated with the use of prophylactic inferior vena cava filter in high-risk trauma patients

Danielle M. Pickham, Rachael A. Callcut, Paul M. Maggio, Matthew Mell, David A. Spain, Fritz Bech, Kristan Staudenmayer

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: It is controversial whether patients at high risk for pulmonary embolism (PE) should receive prophylactic inferior vena cava filters (IVC) filters. This lack of clarity creates the potential for variability and disparities in care. We hypothesized there would be differential use of prophylactic IVC filters for patients at high risk for PE on the basis of insurance status. Methods: We performed a retrospective analysis using the National Trauma Databank (2002-2007). We included adult patients at high risk for PE (traumatic brain injury or spinal cord injury) and excluded patients with a diagnosis of deep venous thrombosis (DVT) or PE. Logistic regression was performed to control for confounders and a hierarchical mixed effects model was used to control for center. Results: A prophylactic filter was placed in 3,331 (4.3%) patients in the study cohort. Patients without insurance had an IVC filter placed less often compared with those with any form of insurance (2.7% vs 4.9%, respectively). After adjusting for confounders, we found that patients without insurance were less likely to receive a prophylactic IVC filter, even when we controlled for center (OR 5.3, P <.001). Conclusion: When guidelines lack clarity, unconscious bias has the potential to create a system with different levels of care based on socioeconomic disparities.

Original languageEnglish (US)
Pages (from-to)232-237
Number of pages6
JournalSurgery (United States)
Volume152
Issue number2
DOIs
StatePublished - Aug 1 2012
Externally publishedYes

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Vena Cava Filters
Pulmonary Embolism
Wounds and Injuries
Insurance
Insurance Coverage
Spinal Cord Injuries
Venous Thrombosis
Cohort Studies
Logistic Models
Databases
Guidelines

ASJC Scopus subject areas

  • Surgery

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Payer status is associated with the use of prophylactic inferior vena cava filter in high-risk trauma patients. / Pickham, Danielle M.; Callcut, Rachael A.; Maggio, Paul M.; Mell, Matthew; Spain, David A.; Bech, Fritz; Staudenmayer, Kristan.

In: Surgery (United States), Vol. 152, No. 2, 01.08.2012, p. 232-237.

Research output: Contribution to journalArticle

Pickham, Danielle M. ; Callcut, Rachael A. ; Maggio, Paul M. ; Mell, Matthew ; Spain, David A. ; Bech, Fritz ; Staudenmayer, Kristan. / Payer status is associated with the use of prophylactic inferior vena cava filter in high-risk trauma patients. In: Surgery (United States). 2012 ; Vol. 152, No. 2. pp. 232-237.
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