Review articleInferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis
Section snippets
Data sources and searches
A comprehensive literature search using PubMed-MEDLINE from 1960 through February 28, 2013, EMBASE from 1980 through February 28, 2013, The Web of Science from 1980 through February 28, 2013, Scopus from 1960 through February 28, 2013 and www.clinicaltrials.gov was conducted by 3 authors (AVH, VP, and AD). The following keywords were used: bariatric surgery, gastric band, gastric bypass, sleeve gastrectomy, pulmonary embolism, venous thromboembolism, and deep vein thrombosis. The search
Study characteristics
Of the 701 selected abstracts, we included 6 studies (n = 102767) for the quantitative synthesis (Fig. 1) [7], [8], [9], [10], [11], [12]. Studies were published between 2006 and 2013, and all patients underwent bariatric surgery (Table 1). One of the authors (DWO) provided additional updated mortality data on his previously published study after IVC filter retrieval [12]. We also used the most recently published outcome data from Birkmeyer et al. [7].
Open surgery (including open Roux-en-Y
Discussion
Our meta-analysis found a significantly higher risk of DVT and an insignificantly higher mortality risk associated with the use of preoperative placement of IVC filters among patients undergoing bariatric surgery and deemed to be high risk for VTE. The risk of PE was similar in the patients who used IVC filters versus those who did not use IVC filters. There was moderate to high heterogeneity of effects among studies for each outcomes evaluated.
Conclusion
Allowing for these caveats, placement of IVC filter before bariatric surgery is associated with the risk of postoperative DVT and overall mortality. There was no change in the risk of PE. Pending evidence from randomized trials, empiric placement of IVC filters before bariatric surgery in high-risk patients may worsen outcomes and should be discontinued for lack of good evidence and because of potential harm.
Disclosures
The authors have no commercial associations that might be a conflict interest in relation to this article.
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