Instructions for Use Violation and Anatomic Factors Are Strongest Predictors of Clinically Significant Type II Endoleaks

Abstract

between surgeon and patient. Use of these tools, however, can be timeconsuming and logistically challenging. We investigated whether simply showing patients their images from preoperative computed tomography (CT) or angiography would improve patient satisfaction with the preoperative discussion. We also examined whether this improved patient knowledge and patient trust and whether it contributed to increased preoperative anxiety. Methods: Consecutive patients undergoing either elective abdominal aortic aneurysm repair or lower limb revascularization were randomly assigned to either standard perioperative discussion or perioperative discussion and review of images (CT or angiography). Randomization was concealed and stratified by surgeon. Primary outcome was patient satisfaction with the preoperative discussion as measured by a validated seven-item scale (score of 0-28), with higher scores indicating improved satisfaction. Secondary outcomes included patient understanding, patient anxiety, patient trust, and length of preoperative discussion. Scores were compared using t-test. Results: Overall, 51 patients were randomized, 25 to the intervention arm (discussion and imaging) and 26 to the control arm. Most patients were male (69%), and average age was 70 years. Patient satisfaction with the discussion was generally high, with no added improvement when preoperative images were reviewed (mean score, 24.9 6 3.02 vs 24.8 6 2.93; P ¼ .88). Similarly, there was no difference in patient anxiety, level of trust, or knowledge when the imaging review was compared with standard discussion. There was a trend toward longer preoperative discussions in the group that underwent imaging review (8.18 vs 6.35 minutes; P ¼ .07). Conclusions: Showing patients their CT or angiography images during the preoperative discussion does not improve patient satisfaction. Similarly, there was no effect on patient trust, knowledge, or anxiety level. Unless patients specifically request imaging review, we would suggest against doing this routinely as it may lengthen the preoperative discussion unnecessarily.