Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis

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Hdl Handle:
http://hdl.handle.net/10757/320268
Title:
Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis
Other Titles:
Inferior vena cava filters and bariatric surgery outcomes
Authors:
Kaw, Roop; Pasupuleti, Vinay; Overby, D.Wayne; Deshpande, Abhishek; Craig I. Coleman Pharm; John P.A. Ioannidis; Hernández, Adrian V. ( 0000-0002-9999-4003 )
Publisher:
Elsevier B.V.
Journal:
Surgery for Obesity and Related Diseases
Issue Date:
9-Jun-2014
URI:
http://hdl.handle.net/10757/320268
DOI:
10.1016/j.soard.2014.04.008
Additional Links:
http://www.sciencedirect.com/science/article/pii/S1550728914001579
Abstract:
Background: Pulmonary embolism (PE) accounts for almost 40% of perioperative deaths after bariatric surgery. Placement of prophylactic inferior vena cava (IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate postoperative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28, 2013. Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity, and Sidik-Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks (RR) and 95% Confidence Intervals (CI). Results: Seven observational studies were identified (n=102,767), with weighted average incidences of DVT (0.9%), PE (1.6%), and mortality (1.0%) for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR 2.81, 95%CI 1.33-5.97, p=0.007; and RR 3.27, 95% CI 0.78-13.64, p=0.1, respectively); there was no difference in the risk of PE (RR 1.02, 95%CI 0.31-3.77, p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery is associated with higher risk of postoperative DVT and mortality. A similar risk of PE in patients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline. Randomized trials are needed before IVC placement can be recommended.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Keywords:
Bariatric surgery; Inferior vena cava filters; Pulmonary embolism; Venous thromboembolism
ISSN:
1550-7289
EISSN:
1878-7533

Full metadata record

DC FieldValue Language
dc.contributor.authorKaw, Roopspa
dc.contributor.authorPasupuleti, Vinayspa
dc.contributor.authorOverby, D.Waynespa
dc.contributor.authorDeshpande, Abhishekspa
dc.contributor.authorCraig I. Coleman Pharmspa
dc.contributor.authorJohn P.A. Ioannidisspa
dc.contributor.authorHernández, Adrian V.spa
dc.date.accessioned2014-06-10T01:26:55Z-
dc.date.available2014-06-10T01:26:55Z-
dc.date.issued2014-06-09-
dc.identifier.issn1550-7289-
dc.identifier.doi10.1016/j.soard.2014.04.008-
dc.identifier.urihttp://hdl.handle.net/10757/320268-
dc.description.abstractBackground: Pulmonary embolism (PE) accounts for almost 40% of perioperative deaths after bariatric surgery. Placement of prophylactic inferior vena cava (IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate postoperative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28, 2013. Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity, and Sidik-Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks (RR) and 95% Confidence Intervals (CI). Results: Seven observational studies were identified (n=102,767), with weighted average incidences of DVT (0.9%), PE (1.6%), and mortality (1.0%) for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR 2.81, 95%CI 1.33-5.97, p=0.007; and RR 3.27, 95% CI 0.78-13.64, p=0.1, respectively); there was no difference in the risk of PE (RR 1.02, 95%CI 0.31-3.77, p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery is associated with higher risk of postoperative DVT and mortality. A similar risk of PE in patients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline. Randomized trials are needed before IVC placement can be recommended.eng
dc.formatapplication/pdfspa
dc.language.isoengeng
dc.publisherElsevier B.V.spa
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S1550728914001579spa
dc.rightsinfo:eu-repo/semantics/openAccessspa
dc.subjectBariatric surgeryspa
dc.subjectInferior vena cava filtersspa
dc.subjectPulmonary embolismspa
dc.subjectVenous thromboembolismspa
dc.titleInferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysisspa
dc.title.alternativeInferior vena cava filters and bariatric surgery outcomeseng
dc.typeinfo:eu-repo/semantics/articlespa
dc.identifier.eissn1878-7533-
dc.identifier.journalSurgery for Obesity and Related Diseasesspa
dc.description.peer-reviewRevisión por paresspa
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