IPC04. Loss to Follow-Up After Endovascular Abdominal Aortic Aneurysm Repair, a Suburban Community Teaching Practice Experience

Abstract

Patient loss to follow-up (LTF), after endovascular aneurysm repair (EVAR), is a recognized Achilles heel of this therapy with potential dire consequences. Previous studies have demonstrated LTF rates of approximately 40% to 50% or more. We sought to find if the LTF rate after EVAR in our suburban community patient population was similar and if the causative factors were the same. A retrospective chart review was performed on all patients who had undergone an EVAR at our medical center between 2010 and 2017. Patients were considered LTF if more than 12 months passed since their last surveillance imaging study. These patients had been previously called and/or sent registered letters at the time of their missed imaging appointments. In those patients in whom there was no recent medical record for review, an Internet search was performed. Up to four attempts at telephone contact were made to all patients thought or known to be alive, after which patients were deemed unreachable. Data collected focused on reasons for LTF and any resultant morbidity or mortality. Descriptive statistics were calculated and reported. Of the 270 patients who underwent an EVAR and survived more than 30 days, 81 (30%) were deemed LTF. The average age of those LTF was 75.1 ± 9.7 years and the majority were male (77%). Twenty-one of the 81 patients (26%) were determined to have died, only one from an aneurysm-related cause, an aortoenteric fistula. The mean length of follow-up in these patients was 1.96 years. Of the remaining 60 patients, 30 (37%) could not be located/reached, 14 (17.2%) were reached but refused any further imaging or care, 8 (9.9%) changed surgeons, 6 (7.4%) had moved out of state and were being followed by a physician, and 2 (2.5%) had advanced illness. Although aneurysm-related death was uncommon in those patients LTF, it is disturbing that even in our comparatively affluent, suburban setting, this occurred in almost one-third of patients treated with EVAR. While our LTF rate was lower than that seen in other published reports, it highlights the need for more robust patient education efforts across all patient populations. Crafting vascular societal guidelines for Electronic Health Record use which include mandates that automated alerts be sent to patients and physicians after EVAR, would likely increase compliance and, in part, achieve the as yet largely unmet promise of this technology to improve patient care.