(384) Post-Vasectomy Semen Analysis Compliance Correlated with Patient Driving Distance to Drop-off Site

Abstract

Abstract Introduction Successful vasectomy is confirmed with post-vasectomy semen analysis (PVSA) completed eight to sixteen weeks after the procedure. However, compliance rates remain low throughout the literature with an estimated 34% to 58% of patients never receiving a PVSA. Objective We sought to quantify the relationship between driving time and compliance with PVSA. Methods A retrospective chart review was conducted of vasectomies provided by urologists from an academic hospital system between 4/1/2020 and 12/31/2022. Physicians who primarily performed in-office PVSA or referred patients to outside clinics were excluded from the study. Compliance with post-vasectomy semen analysis was defined as at least 1 PVSA sample submitted. In our study we considered variables including age, virtual or in-person preoperative visit, paternity, and driving time. The shortest driving time was calculated from each patient’s residence to the single PVSA drop-off site using ArcGIS. The study received IRB approval. The factors associated with compliance were analyzed via multivariable logistic regression. Driving time, age at vasectomy, paternity, and preop location were included as predictors. Driving time and age were included as continuous variables. For driving time the odds ratio reflects the change in odds of PVSA per 30 minutes of driving; for age the odds ratio reflects the change in odds of PVSA per 10 years of age. A generalized additive model was used to explore a nonlinear relationship between driving time and PVSA compliance. Results A total of 515 patients were included in the analysis. 296 patients obtained a PVSA (57.5%). Of those who obtained a PVSA, 41% took more than 16 weeks to do so. The median driving distance for those who obtained a PVSA was 18.9 miles (11.3, 26.4) and 22.3 miles (13.9, 34.3) for those who did not (p<0.01). The median estimated driving times for those who did and did not provide PVSA were 30.6 minutes (23.0, 42.1) and 34.2 minutes (25.5, 46.8) respectively (p<0.05). Adjusted for age, paternity, and pre-op location, each 30 minutes of driving time was associated with a 48% (63%, 27%) reduction in the odds of obtaining a PVSA (p<0.001). Age at vasectomy, paternity, and pre-op location were not found to be associated with decreased PVSA compliance. (Table 1). The generalized additive model shows a similar relationship between driving distance and compliance (Figure 1). Conclusions These results demonstrate a statistically significant correlation between longer driving time to a drop-off site and probability of PVSA non-compliance. However, factors such as paternity, age at vasectomy, and pre-op visit format were not significant. Increasing access to semen analysis drop-off centers close to patients residences may serve to increase compliance with PVSA. At-home PVSA kits and in-office semen analyses are other options for reducing this barrier. Further research is needed to see if this relationship between driving time and compliance is seen in other aspects of medical care. Disclosure No.