Patient satisfaction and chronic illness are predictors of postendovascular aneurysm repair surveillance compliance

Abstract

ObjectiveAlthough lifelong surveillance is recommended by the Society for Vascular Surgery for patients undergoing endovascular aneurysm repair (EVAR) reported that compliance with long-term follow-up has been poor. We sought to identify factors that predict compliance with EVAR surveillance through analysis of patient variables and post-EVAR questionnaire results. MethodsWe analyzed 28 patient variables gathered from our computerized registry, patient charts, and phone questionnaires of patients who underwent EVAR between January 1, 2010, and December 31, 2014. These factors included patient demographics, education, postoperative complications, satisfaction with vascular surgery care, transportation mode, distance to our medical center, and living situation. Compliance was defined as a patient who underwent the most recent recommended follow-up surveillance study within the prescribed timeframe. Post-EVAR surveillance protocol consisted of office evaluation and duplex ultrasound examination performed in our accredited noninvasive vascular laboratory at 1 week, 6 months, then annually. Computed tomography angiography was obtained only if duplex ultrasound examination suggested endoleak, sac enlargement of more than 5 mm, or a failing limb. ResultsOf 144 patients who underwent EVAR during this time period, 89 patients (62%) were compliant with the most recent recommended follow-up study. One hundred two patients completed the questionnaire or their families did if patients died or were incapacitated. Of those, 80 were compliant with follow-up and 22 were not. Based on the questionnaires of these 102 patients, estimated compliance at 3 years after EVAR was 69.6 ± 6.0% based on Kaplan-Meier analysis. In the compliant vs noncompliant groups, the estimated 3-year survival rate was 93.2 ± 3.4% vs 52.4 ± 12.7%, respectively (P < .001), and the estimated 5-year survival rate was 83.1 ± 6.4% vs 34.4 ± 13.4%, respectively (P < .001), respectively. However, none of the mortalities observed in the noncompliant group were aneurysm related. Adverse neurologic events after EVAR demonstrated a trend predicting noncompliance after 5 years based on multivariate Cox regression analysis (hazard ratio [HR], 2.57; 95% confidence interval [CI], 0.95-6.90; P = .062). Patient dissatisfaction with their vascular surgeon and hospital care predicted noncompliance with recommended postoperative surveillance (HR, 5.0; 95% CI, 1.52-16.7; P = .008). College education or higher was associated with compliance (HR, 0.28; 95% CI, 0.06-1.23; P = .092). No other variables, including postoperative complications or distance from the hospital, predicted follow-up noncompliance. ConclusionsPatient satisfaction with their vascular surgeon and hospital experience predicted compliance with post-EVAR surveillance regardless of postoperative complications. Noncompliant patients had decreased survival, but mortality and surveillance noncompliance were likely due to disabling chronic disease.