Post-Endovascular Aneurysm Repair Patient Outcomes and Follow-Up Are Not Adversely Impacted by Long Travel Distance to Tertiary Vascular Surgery Centers

Sarangarm, Dusadee; Knepper, Jordan; Marek, John; Biggs, Kristen L.; Robertson, Diane C.; Langsfeld, Mark

doi:10.1016/j.avsg.2010.05.009

Cited by 25 publications

(27 citation statements)

References 24 publications

(32 reference statements)

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“…13,14 With this centralization of EVAR comes a concern about compliance of the patient with postoperative surveillance. Although some data exist suggesting that distance from a tertiary care center is not a limiting factor in the patient’s adherence to follow-up after EVAR, 15 others have shown that shorter driving distances are independent predictors of compliance with postoperative imaging surveillance. 3 As such, one potential solution to improve the compliance of patients while minimizing cost and time burdens would be to limit the number of in-person follow-up visits needed after EVAR.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…However, this is not supported by other reports [12][13][14]. For instance, a study performed at the Veterans Affairs Medical Center (VAMC) in Albuquerque, New Mexico examined 136 patients living ≤100 miles or >100 miles away from the VAMC [18]. No difference in compliance was found between the two groups, suggesting that a comprehensive electronic records database, an organized and funded patient transportation system, and fewer financial barriers due to VAMC benefits may contribute to adherence to scheduled visits despite the traveling distance.…”

Section: Discussionmentioning

confidence: 85%

Factors Affecting Follow-Up Compliance in Patients After Endovascular Aneurysm Repair

Jasinski

Labropoulos

Christoforatos

et al. 2017

Aorta

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Objective: The purpose of this study was to evaluate potential factors affecting patient non-compliance after endovascular aneurysm repair. Method: We performed a retrospective review of patients undergoing elective or emergency endovascular repair for thoracic, abdominal aorta, or iliac artery aneurysm at a single institution from November 2007 to March 2014. Compliance to follow-up at 1, 6, and 12 months was assessed. Factors evaluated included patient demographics, size of aneurysm, distance between the patient's residence and outpatient clinic, urgency of surgery, and time of year in which the follow-up visits were scheduled. Results: During the study period, 205 patients (75% male and 25% female) fulfilled the inclusion criteria. One-month mortality was 1.1% for elective procedures and 16.1% for emergency procedures (p = 0.001). Overall mortality at 12 months was 6.3% and 32.3% for elective and emergency procedures, respectively (p = 0.0002). Highest compliance was observed at 1 month, with 184 patients (93%) attending. A significant decrease was seen at 6 (n = 102, 54%) and 12 (n = 89, 48%) months. At the 12-month mark, a larger proportion of minority patients were non-compliant compared with Caucasian patients. Confounders for non-compliance were analyzed using multivariate analysis, and statistical significance was found for widowed marital status (p = 0.008), travel distance >25 miles to the outpatient clinic (p = 0.032), and emergency repair of aneurysms (p = 0.022). Conclusion: Despite emphasizing the importance of follow-up after endovascular aortic procedures, almost half of the treated patients were non-compliant. Our study identified travel distance, marital status, and urgency of surgery as factors that may affect patients' compliance to scheduled follow-up visits.

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“…9,11 Although some authors found geographic factors, such as rural or small-town residence or increased distance to the hospital adversely affected compliance, 9 others found no difference. 11,18 Urgent or emergent treatment, and EVAR for ruptured AAA, were found to be significant factors for compliance failure and loss to follow-up in studies by Schanzer et al 10 and Garg et al 9 Other medical comorbidities, such as congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, chronic renal insufficiency, diabetes, and cancer also significantly contributed to poor compliance. 9,10 In our study, peripheral artery disease, carotid artery disease, and patients with HN anatomy appeared to adversely affect compliance; however, after multivariate analysis, only patients with carotid artery disease or HN anatomy showed statistical significance.…”

Section: Discussionmentioning

confidence: 98%

Compliance of postendovascular aortic aneurysm repair imaging surveillance

AbuRahma

Yacoub

Hass

et al. 2016

Journal of Vascular Surgery

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Objective Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes. Methods Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities. Results Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P< .0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endolcak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance. Conclusions Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.

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Post-Endovascular Aneurysm Repair Patient Outcomes and Follow-Up Are Not Adversely Impacted by Long Travel Distance to Tertiary Vascular Surgery Centers

Abstract: Distance from a tertiary care center is not a limiting factor in patient adherence to follow-up, patient graft-related morbidity, or patient survival, likely because of the Albuquerque VA Medical Center's electronic tracking of patients and provision of travel vouchers.

Cited by 25 publications

References 24 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

Factors Affecting Follow-Up Compliance in Patients After Endovascular Aneurysm Repair

Compliance of postendovascular aortic aneurysm repair imaging surveillance

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