Distressed Communities Have Increased Odds of Undergoing an Endovascular Aortic Aneurysm Repair for Symptomatic Abdominal Aortic Aneurysm and Higher Likelihood of Loss to Follow-up: A Study from VQI Database

Abstract

Introduction: Evidence suggests that patients from distressed communities have poorer surgical outcomes. This study aims to assess the preoperative factors and outcomes of endovascular aortic aneurysm repair (EVAR) among the patients from distressed communities. Methods: VQI Database from 2003-2021 was used. Two study groups were yielded based on the distressed communities index: Group I comprised of distressed patients (two highest quintiles), and Group II included non-distressed patients (first three quintiles). Univariate and multivariate regression analyses were performed to measure the outcomes, and analyze other variables. Urgency of procedure, and long-term follow-up was defined as primary outcomes of the study. Results: Of the 60,972 patients, 18,549 (30.4%) were in Group I and 42,423 (69.6%) were in Group II. It was observed that patients in Distressed group (Group I) had relatively more females, African Americans, poor functional status, smokers, and multiple comorbidities. This group had higher risk of undergoing EVAR for symptomatic (11.1% vs 7.9%, AOR: 1.25 [1.15, 1.37] p < 0.001). However, no significant difference was observed for anteroposterior abdominal aortic aneurysm (AAA) diameter between the two groups. A long-term follow-up was less observed for the patients in Group I (28.9% vs 26.3%). There was no significant difference of 30-day mortality, however, 1-year mortality risk was higher in Group-I (AOR: 1.12 [1.01, 1.22] p = 0.041). Conclusion: Patients from distressed communities are more likely to undergo EVAR for symptomatic AAA and higher probability of loss to follow-up. This necessitates an early screening for vulnerable populations, and healthcare planning to ensure a continuum of care for underprivileged patients.