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 language | English (US) |
|---|---|
| Pages (from-to) | 232-237 |
| Number of pages | 6 |
| Journal | Surgery (United States) |
| Volume | 152 |
| Issue number | 2 |
| DOIs | |
| State | Published - Aug 1 2012 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Payer status is associated with the use of prophylactic inferior vena cava filter in high-risk trauma patients
AU - Pickham, Danielle M.
AU - Callcut, Rachael A.
AU - Maggio, Paul M.
AU - Mell, Matthew
AU - Spain, David A.
AU - Bech, Fritz
AU - Staudenmayer, Kristan
PY - 2012/8/1
Y1 - 2012/8/1
N2 - 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.
AB - 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.
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UR - http://www.scopus.com/inward/citedby.url?scp=84864193075&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2012.05.041
DO - 10.1016/j.surg.2012.05.041
M3 - Article
VL - 152
SP - 232
EP - 237
JO - Surgery (United States)
JF - Surgery (United States)
SN - 0039-6060
IS - 2
ER -