Patient Satisfaction and Chronic Illness are Predictors of Post-EVAR Surveillance Compliance
Sam C. Tyagi, MD1, Shinichi Fukuhara2, Jacques Greenberg, MD1, Danielle M. Pineda1, Hong Zheng1, Matthew J. Dougherty1, Douglas A. Troutman1, Keith D. Calligaro1.
1Pennsylvania Hospital, Philadelphia, PA, USA, 2Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Objective(s): Although lifelong surveillance is recommended by the Society for Vascular Surgery (SVS) for patients undergoing endovascular aneurysm repair (EVAR), reported compliance with long-term follow-up has been poor. We sought to identify factors that predict compliance of EVAR surveillance through analysis of patient variables and results of a questionnaire mailed to patients post-EVAR.
Methods: We analyzed 25 patient variables gathered from our computerized registry, patient charts, and questionnaires to patients who underwent EVAR between January 1, 2010 - December 31, 2014. These factors included patient demographics, postoperative complications, post-operative morbidities, satisfaction with vascular surgery care, transportation, distance to our medical center, and living situation. Compliance was defined as a patient who underwent the most recent recommended follow-up surveillance study. Our post-EVAR surveillance protocol consisted of office evaluation and duplex ultrasound (DU) performed in our accredited non-invasive vascular laboratory at one week, six months and then annually. CT-A was obtained only if DU suggested endoleak, sac enlargement > 5 mms, or a failing limb.
Results: Of 144 EVARs performed during this time period, only 89 (62%) patients were compliant with the most recent recommended follow-up study. One-hundred two patients completed the questionnaire (or their families if patients had expired or were incapacitated): 80 were compliant with follow-up and 22 were not. Based on the questionnaires of these 102 patients, estimated compliance at 3 years post-EVAR was 69.6 +/- 6.0 % based on Kaplan-Meier analysis. In the compliant and non-complaint groups, the estimated survival rate was 93.2 +/- 3.4% vs. 52.4 +/- 12.7% at 3 years (p<0.001) and 83.1 +/- 6.4% vs. 34.4 +/- 13.4% at 5 years (p<0.001), respectively. However, none of the mortalities observed in the non-compliant group were aneurysm related. Stroke and heart failure during follow-up after EVAR demonstrated a trend predicting non-compliance at 5 years post-EVAR based on multivariate analysis (p= 0.076), while patient satisfaction with their surgeon and hospital-care predicted compliance with recommended postoperative surveillance (p=0.016). No other variables, including post-operative complications or distance from our hospital, predicted compliance with follow-up.
Conclusions: Patient satisfaction with their vascular surgeon and hospital experience were predictive of compliance with post-EVAR surveillance regardless of post-operative complications. Non-compliant patients had decreased survival, but mortalities and non-compliance with surveillance studies were most likely due to disabling chronic disease.
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