Association of inferior vena cava filter placement with perioperative outcomes after bariatric surgery: a contemporary analysis of 721,161 patients.

Background: Inferior vena cava filters (IVCFs) are utilized to mitigate the incidence of thromboembolic complications after bariatric surgery.

Objectives: This study compared 30-day outcomes between patients with and without IVCFs present at the time of sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).

Setting: Patients reported to the 2018-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.

Methods: Adults undergoing primary SG or RYGB, with and without IVCFs present (SG-IVCF and SG-only or RYGB-IVCF and RYGB-only, respectively), were identified. Baseline characteristics by IVCF status for each procedure were adjusted using entropy balancing. Multivariable weighted logistic and linear regressions were subsequently developed to evaluate the independent association between the presence of IVCF at the time of bariatric surgery and outcomes of interest.

Results: Of 721,161 patients included, 71.9% (n = 518,454) underwent SG and 28.1% (n = 202,707) underwent RYGB, of which .3% (n = 1471) and .3% (n = 643) had IVCFs present, respectively. Compared to SG-only and RYGB-only, SG-IVCF and RYGB-IVCF had higher unadjusted 30-day rates of deep vein thrombosis, while only RYGB-IVCF had higher rates of pulmonary embolism (PE). After multivariate adjustment, SG-IVCF was associated with significantly higher odds of unplanned intensive care unit admission, reoperation, and ED visit, but lower odds of PE. RYGB-IVCF demonstrated higher odds of reoperation but no association with PE. Both SG-IVCF and RYGB-IVCF were linked to a lower likelihood of mortality.

Conclusions: While IVCFs may associate with distinct outcomes by procedure, this study did not indicate a clear protective effect, instead demonstrating an association with greater postoperative morbidity after risk adjustment.