Abstract No. 104 National trends in inferior vena cava filter placement and retrieval: how are we doing?

Prior studies demonstrate a marked increase and subsequent decrease in the number of inferior vena cava (IVC) filters placed over the last several decades. The aim of this analysis was to evaluate national recent trends in placement and removal of IVC filters in the Medicare population using the most recent data available. Medicare Physician Supplier Procedure Summary aggregate master files from 2012 to 2018 were obtained from the Centers of Medicare and Medicaid Services. IVC filter placement and removal procedures were identified using Common Procedural Terminology (CPT) codes. The rate of IVC filter placement and removal were evaluated. Specialty type was isolated using provider specialty codes. Radiologists included interventional and diagnostic radiology specialty codes. Surgical specialties included general, vascular, thoracic, and cardiac surgery. Cardiology included internal medicine and cardiology specialty codes. Further analysis to evaluate the number of aborted IVC filter removal procedures were isolated by initial and secondary modifier codes. There were 315,990 filters placed and 45,429 removed from 2012 to 2018. Radiologists placed and removed the majority of IVC filters (62% and 65%, respectively), followed by surgeons (28% and 25%), and cardiologists (7% and 6%). The number of IVC filters placed per year decreased 49.9% from 61,890 filters to 31,003 filters. When controlled for increasing Medicare enrollment, IVC filter placements decreased by 51.8% (166.3 vs 80.2 per 100,000 enrollees). IVC filter removal procedures increased by 84.9%, from 4,327 to 8,002 over the study period; this represented a 78% increase when controlled for Medicare enrollment (11.6 vs 20.7 removals per 100,000 enrollees). Radiologists had a slightly higher ratio of IVC filter placements to removals than surgeons and cardiologists (6.6 for radiologists, 7.9 for surgeons, and 7.8 for cardiologists). Radiologists had the lowest percentage of aborted IVC filter removals (2.2%) compared to surgeons (4.1%) and cardiologists (3.2%). IVC filter placement in the Medicare population dropped in half between 2012 and 2018, while IVC filter removal procedures increased by approximately 85%. The majority of IVC filter and removal is performed by radiologists, who place slightly more filters than they retrieve compared to other specialties but also demonstrate the lowest filter retrieval abortion rates when compared to surgeons and cardiologists.