Postoperative Surveillance and Long-term Outcomes After XXXX Repair Among Medicare Beneficiaries.

@entity1 @entity449 @entity1755 @entity439 @entity397 @entity1028
Importance: The Society for Vascular Surgery recommends annual surveillance with computed tomography (CT) or ultrasonography after endovascular @entity449 repair (EVAR) for @entity1028 . However, such lifelong surveillance may be unnecessary for most @entity1 , thereby contributing to overuse of imaging services. Objective: To investigate whether nonadherence to Society for Vascular Surgery-recommended surveillance guidelines worsens long-term outcomes after EVAR among Medicare beneficiaries. Design, Setting, and @entity1 : We collected data from Medicare claims from January 1, 2002, through December 31, 2011. A total of 9503 @entity1 covered by fee-for-service Medicare who underwent EVAR from January 1, 2002, through December 31, 2005, were categorized as receiving complete or incomplete surveillance. We performed logistic regressions controlling for @entity1 demographic and hospital characteristics. @entity1 were then matched by propensity score with adjusting for all demographic variables, including age, sex, race, Medicaid eligibility, residential status, hospital volume, @entity1755 , and all preexisting comorbidities. We then calculated differences in long-term outcomes after EVAR between adjusted groups. Data analysis was performed from January 1, 2002, through December 31, 2011. Main Outcomes and Measures: Post-EVAR imaging modality, @entity439 -related mortality, late @entity397 , and complications. Results: Median follow-up duration was 6.1 years. Incomplete surveillance was observed in 5526 of 9695 @entity1 (57.0%) who survived the initial hospital stay at a mean (SD) of 5.2 (2.9) years after EVAR. After propensity matching, our cohort consisted of 7888 @entity1 , among whom 3944 (50.0%) had incomplete surveillance. For those in the matched cohort, @entity1 with incomplete surveillance had a lower incidence of late @entity397 (26 of 3944 [0.7%] vs 57 of 3944 [1.4%]; P   =   .001) and major or minor reinterventions (46 of 3944 [1.2%] vs 246 of 3944 [6.2%]; P   <   .001) in unadjusted analysis. Aneurysm-related mortality was not statistically different between groups (13 of 3944 [0.3%] vs 24 of 3944 [0.6%]; P   =   .07). In adjusted analysis of postoperative outcomes controlling for all @entity1 and hospital factors by the tenth postoperative year, @entity1 in the incomplete surveillance group experienced lower rates of total complications (2.1% vs 14.0%; P   <   .001), late @entity397 (1.1% vs 5.3%; P   <   .001), major or minor reinterventions (1.4% vs 10.0%; P   <   .001), @entity439 -related mortality (0.4% vs 1.3%; P   <   .001), and all-cause mortality (30.9% vs 68.8%, P   <   .001). Conclusions and Relevance: Nonadherence to the Society for Vascular Surgery guidelines for post-EVAR imaging was not associated with poor outcomes, suggesting that, in many @entity1 , less frequent surveillance is not associated with worse outcomes. Improved criteria for defining optimal surveillance will achieve higher value in @entity439 care.
