Follow-Up Compliance After Endovascular Abdominal Aortic Aneurysm Repair in Medicare Beneficiaries

Abstract

Life-long imaging follow-up is essential to the safe and appropriate management of patients who undergo endovascular abdominal aortic aneurysm repair (EVAR). We sought to evaluate the rate of compliance with imaging follow-up post-EVAR and to identify factors associated with being lost to imaging follow-up. We identified a 20% sample of continuously enrolled Medicare beneficiaries who underwent EVAR between 2001 and 2008. Using data through 2010 from Medicare Inpatient, Outpatient, and Carrier files, we identified all abdominal imaging studies that might have been performed for EVAR follow-up. Patients were considered lost to annual imaging follow-up if they did not undergo any abdominal imaging study within their last 2 years of follow-up. Multivariable models were constructed to identify independent determinants of being lost to annual imaging follow-up. Among 19,962 patients who underwent EVAR, the incidence of loss to annual imaging follow-up at 5 years post-EVAR was 50%. Primary independent determinants of lost to annual imaging follow-up were advanced age of 75 to 79 years (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.15-1.32), 80 to 85 years (HR, 1.45; 95% CI 1.35-1.55), and >85 years (HR, 2.03; 95% CI, 1.88-2.20), and presentation with an urgent/emergent intact aneurysm (HR, 1.27; 95% CI, 1.20-1.35) or ruptured aneurysm (HR, 1.84; 95% CI, 1.63-2.08). Additional independent factors included several previously diagnosed chronic diseases and South and West regions of the United States. Annual imaging follow-up compliance post-EVAR in the United States is significantly below recommended levels. Quality improvement efforts to encourage improved compliance with imaging follow-up, especially in older patients with multiple comorbidities and in those who underwent EVAR urgently or for rupture, are necessary.