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SIR 2026

Scientific Session

Venous Interventions

Session: Venous Interventions 2

364 - IVC Filters in Acute Pulmonary Embolism: A National Inpatient Sample Propensity-Matched Analysis of In-Hospital Outcomes (2016–2020)

Wednesday, April 15, 2026
11:15 AM - 11:24 AM ET
Purpose: To evaluate the association between inferior vena cava (IVC) filter placement and in-hospital outcomes among adults hospitalized with acute pulmonary embolism (PE), including effect modification by hemodynamic stability.

Materials and Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2020). Adult hospitalizations with a principal diagnosis of PE were identified by ICD-10 codes. The exposure was IVC filter placement (ICD-10-PCS). Propensity score matching (1:3) was used to balance 27 covariates with exact matching on PE stability (stable vs unstable). Logistic regression estimated the adjusted odds of in-hospital mortality; generalized linear models estimated length of stay (LOS) and total hospital charges. Pre-specified subgroup analyses assessed interaction by PE stability.

Results: Of 196,231 PE hospitalizations, 186,845 met inclusion criteria; 10,719 (5.7%) received an IVC filter. Use declined from 6.8% (2016) to 4.8% (2020) (p for trend < 0.001). Propensity matching yielded 10,714 IVC-filter cases and 34,708 controls (n=45,398). In the matched cohort, in-hospital mortality was 4.5% with filters vs 5.1% without (adjusted OR 0.87, 95% CI 0.78–0.96; p=0.008). IVC filter placement was associated with greater resource utilization: mean LOS 7.99 vs 4.50 days (rate ratio 1.77, 95% CI 1.74–1.81; p< 0.001) and mean charges $118,943 vs $51,981 (rate ratio 2.29, 95% CI 2.23–2.35; p< 0.001). Subgroup analysis demonstrated significant interaction by clinical severity: in unstable PE, mortality was lower with filters (23.6% vs 42.1%; interaction p< 0.001), whereas in stable PE, mortality was slightly higher with filters (1.91% vs 1.13%).

Conclusion: In a large, contemporary US cohort, IVC filter placement was associated with a modest reduction in in-hospital mortality overall, driven by substantial benefit in hemodynamically unstable PE, but not in stable PE. Filter use was consistently linked to longer hospitalizations and higher charges. These findings support selective, stability-guided IVC filter use and underscore the need to weigh short-term survival benefits against increased resource utilization and potential longer-term risks highlighted in prior literature.