Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection

Kret, Marcus R.; Azarbal, Amir F.; Mitchell, Erica L.; Liem, Timothy K.; Landry, Gregory J.; Moneta, Gregory L.

doi:10.1016/j.jvs.2012.12.046

Cited by 61 publications

(52 citation statements)

References 17 publications

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“…However, postoperative imaging was available in 85% of patients who followed up in person, compared with only 56% of patients who had phone call follow-up, which may explain the differences in outcomes. Although existing reports suggest that routine postoperative surveillance after EVAR may not be necessary in all patients, 2,5,9,11 our data suggest that in-person follow-up is associated with both better survival and better postoperative imaging surveillance compliance compared with phone call follow-up. It is unclear whether phone call follow-up with appropriate post-EVAR imaging would mitigate this difference, especially in cases in which the imaging is performed locally; centers not experienced with postoperative EVAR surveillance may not have the same quality or expertise of ultrasound imaging as centers with substantial EVAR experience.…”

Section: Discussioncontrasting

confidence: 59%

“…5 Similar findings have been demonstrated using institutional cohorts as well. 9-11 However, our study is different from these prior reports on post-EVAR imaging surveillance because it deals specifically with patient follow-up visits after EVAR. Notably, of the 22,000 patients undergoing EVAR during the study period, <60% had recorded follow-up; 11% of patients were LTF, 11% of patients were restricted to phone call follow-up only, and 42% of all EVAR patients had no entry in the follow-up data field in the VQI database.…”

Section: Discussionmentioning

confidence: 94%

“…1 However, recent reports have called the utility of these guidelines into question. 5,9-11 In addition, it is unclear whether in-person follow-up is needed as an adjunct to postoperative surveillance imaging for post-EVAR patients.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Hicks

Zarkowsky

Bostock

et al. 2017

Journal of Vascular Surgery

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Background Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with computed tomography imaging for the year after endovascular aneurysm repair (EVAR). We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). Methods All patients undergoing elective EVAR in the Vascular Quality Initiative (VQI) data set (January 2003-December 2015) were stratified according to long-term follow-up method (in-person vs phone call vs LTF). Mortality was captured for all patients by linkage with the Social Security Death Index. Univariable statistics, Kaplan-Meier estimated survival curves, and Cox proportional hazard modeling were used to compare groups. Coarsened exact matching analysis was then performed to refine the association between LTF and risk of post-EVAR death. Results During the study period, 11,309 patients underwent elective EVAR (78% in-person follow-up, 11% phone call follow-up, 11% LTF). On univariable analysis, LTF patients had larger baseline aneurysms, higher American Society of Anesthesiologists scores, more comorbidities, and worse baseline functional status compared to patients with in-person or phone call follow-up (P ≤ .05). Procedural factors (contrast material volume, blood transfusions, postoperative vasopressor use) were higher in the LTF group, as was the incidence of postoperative complications (P ≤ .05). Accordingly, LTF patients had longer postoperative lengths of stay and were less frequently discharged to home (P < .001). Five-year survival was lower for LTF vs phone call follow-up vs in-person follow-up (62% vs 68% vs 84%; P < .001). On multivariable analysis correcting for baseline differences between groups, there was a significantly higher risk of death for both the LTF group (hazard ratio, 6.45; 95% confidence interval, 4.89-8.51) and phone call follow-up group (hazard ratio, 3.48; 95% confidence interval, 2.66-4.57) compared with patients who followed up in person (P < .001). After coarsened exact matching on 30 preoperative and perioperative variables, 5-year survival after EVAR for LTF vs phone call follow-up vs in-person follow-up was 84.9% vs 84.8% vs 91.9%, respectively (log-rank, P < .001). Notably, patients with phone call follow-up had a lower prevalence of documented postoperative imaging compared with patients with in-person follow-up (56.1% vs 85.1%; P < .001). Conclusions EVAR patients with more comorbidities and a higher incidence of in-hospital complications tend to be more frequently LTF and ultimately have worse survival outcomes. In-person follow-up is associated with better post-EVAR survival and a higher rate of postoperative imaging. Phone follow-up confers a mortality risk equivalent to lack of follow-up, possibly as a result of inadequate postoperative imaging. Surgeons should stress the importance of office-based postoperative follow-up to all EVAR patients, particularly those with poor baseline health and functional status and more complicated perioperative courses.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 94%

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Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Hicks

Zarkowsky

Bostock

et al. 2017

Journal of Vascular Surgery

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“…In another single center review with a more heterogeneous population (patients underwent EVAR, endovascular thoracic aneurysm repair, or medical management for Type B aortic dissection), imaging follow-up compliance was assessed in 204 patients. 16 At an average follow-up of 28 months, 56% of patients were lost to imaging follow-up (defined as >1 year since last imaging).…”

Section: Discussionmentioning

confidence: 99%

“…11, 12 We hypothesized that among Medicare beneficiaries treated with EVAR, a significant proportion of patients are lost to annual imaging follow-up, and that there are several patient characteristics associated with loss to annual imaging follow-up. To test this hypothesis, we examined Medicare claims data in order to identify a group of patients who underwent EVAR between 2001 and 2008 and estimated the proportion lost to imaging follow-up over an extended duration of follow-up.…”

Section: Introductionmentioning

confidence: 99%

Follow-up compliance after endovascular abdominal aortic aneurysm repair in Medicare beneficiaries

Schanzer

Messina

Ghosh

et al. 2015

Journal of Vascular Surgery

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Objective Life-long imaging follow-up is essential to the safe and appropriate management of patients who undergo endovascular abdominal aortic aneurysm repair (EVAR). We sought to evaluate the rate of compliance with imaging follow-up post EVAR and to identify factors associated with being lost to imaging follow-up. Methods We identified a 20% sample of continuously enrolled Medicare beneficiaries who underwent EVAR between 2001 and 2008. Using data through 2010 from Medicare Inpatient, Outpatient, and Carrier files, we identified all abdominal imaging studies that may have been performed for EVAR follow-up. Patients were considered lost to annual imaging follow-up if they did not undergo any abdominal imaging study within their last two years of follow-up. Multivariable models were constructed to identify independent factors associated with being lost to annual imaging follow-up. Results Among 19,962 patients who underwent EVAR, the incidence of loss to annual imaging follow-up at 5 years post EVAR was 50%. Primary factors associated with being lost to annual imaging follow-up were advanced age (age 65-69 years, reference, age 75-79, HR, 1.23 [95% CI, 1.15-1.32]), (age 80-85, HR, 1.45, [95% CI 1.35-1.55]), (age >85, HR 2.03, [95% CI 1.88-2.20]) and presentation with an urgent/emergent intact aneurysm (HR, 1.27 [95% CI, 1.20-1.35]) or ruptured aneurysm (HR, 1.84 [95% CI, 1.63-2.08]). Additional independent factors included several previously diagnosed chronic diseases and South and West regions of the US. Conclusions Annual imaging follow-up compliance post EVAR in the United States is significantly below recommended levels. Quality improvement efforts to encourage improved compliance with imaging follow-up, especially in older patients with multiple comorbidities and in those who underwent EVAR urgently or for rupture, are necessary.

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Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries

2015

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Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection

Cited by 61 publications

References 17 publications

Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Follow-up compliance after endovascular abdominal aortic aneurysm repair in Medicare beneficiaries

Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries

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