Predictors of compliance with surveillance after XXXX repair and comparative survival outcomes.

@entity1 @entity6100 @entity64 @entity63 @entity439 @entity1028
OBJECTIVE: Although imaging surveillance is mandatory for all @entity1 after @entity439 repair (EVAR), many @entity1 are not compliant with follow-up. We sought to determine predictors of compliance with EVAR surveillance and to examine how compliance with current surveillance protocols correlates with survival. METHODS: We analyzed 188 @entity1 who underwent EVAR at our institution for @entity1028 (AAAs) between 2001 and 2011. The primary end point was compliance with post-EVAR surveillance recommendations. Univariate analysis included @entity1 demographics and socioeconomic information, AAA characteristics, EVAR hospital course variables, late complications and secondary interventions, length of follow-up, smoking status, family history of AAA, driving distances, primary care providers, and medical comorbidities. Mortality was determined by the Social Security Death Index. Multinomial logistic regressions were fit to identify independent predictors of compliance. Survival plots were generated with the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate Cox regression analysis was used to determine effect of compliance on survival after adjusting for confounders. RESULTS: Of 188 @entity1 , 89 (47.3%) were 100% compliant with follow-up visits and imaging, 21 (11.1%) were moderately compliant by missing appointments, and 78 (41.4%) were lost to follow-up completely. Overall median age was 74  years, and 81.9% of @entity1 were male. Late complications occurred in 77 @entity1 (40.9%), secondary interventions were performed in 32 @entity1 (17%), and 5-year mortality was 21.2%. Mean follow-up interval was >40  months for 100% compliant and moderately compliant @entity1 and  <20  months for those lost to follow-up (P  < .0001). In adjusted analysis, late complications (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.32-5.55; P  = .007), @entity6100 (OR, 2.43; 95% CI, 1.12-5.27; P  = .024), and family history of AAA (OR, 2.67; 95% CI, 1.06-6.75; P  = .037) were associated with 100% compliance, whereas shorter driving distances (P  = .051) and shorter hospital stay (P  = .056) approached significance. Transient @entity63 attack or @entity64 (OR, 3.59; 95% CI, 1.18-10.91; P  = .024) was the only variable independently associated with moderate compliance. Compared with @entity1 lost to follow-up, 100% compliant @entity1 had worse survival (log-rank test, P  = .033), whereas moderately compliant @entity1 ' survival was not significantly different (log-rank test, P  = .149). In adjusted Cox regression analysis, 100% compliant @entity1 had decreased survival duration (rate ratio, 2.67; 95% CI, 1.18-6.06; P  = .018) compared with those lost to follow-up. CONCLUSIONS: Follow-up surveillance is incomplete for more than half of @entity1 who undergo EVAR at our institution, and @entity1 compliance can be predicted by covariates mentioned before. Compliance with current surveillance regimens does not confer a survival benefit. Further research individualizing surveillance protocols based on risk level of late complications and noncompliance and prospective studies examining resulting survival benefits of compliance are warranted.
