Determinants of Follow-Up Failure in Patients Undergoing Vascular Surgery Procedures
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Authors
Judelson, Dejah R.Simons, Jessica P.
Flahive, Julie
Patel, Virendra I.
Healey, Christopher T.
Nolan, Brian W.
Bertges, Daniel J.
Schanzer, Andres
UMass Chan Affiliations
Department of Surgery, Division of Vascular and Endovascular SurgeryDocument Type
Journal ArticlePublication Date
2017-04-01Keywords
Surgery
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BACKGROUND: The Vascular Study Group of New England (VSGNE) requires documentation of follow-up for >80% of patients at least 9 months postprocedure. However, many participating groups fall short of this goal. We sought to identify factors independently associated with loss to long-term follow-up (LTF). METHODS: The VSGNE was queried from 2008 to 2012, for all carotid endarterectomy (CEA), endovascular aneurysm repair (EVAR), open abdominal aortic aneurysm repair (OPEN), infrainguinal bypass (INFRA), and suprainguinal bypass (SUPRA) procedures in patients who survived greater than 9 months postprocedure. Our primary endpoint was loss to LTF, with LTF defined as documentation of a phone call or office visit >/=9 months postprocedure. Multivariable logistic regression was used to identify independent predictors of loss to LTF. Covariates included patient and procedural characteristics, and treatment center/physician. Relative contributions of covariates to the model were assessed by evaluation of the relative model Wald chi-squared values. RESULTS: We identified 14,452 procedures (6567 CEA, 2391 EVAR, 3356 INFRA, 979 OPEN, and 1159 SUPRA). Of those, 4669 (32%) were lost to LTF. Rates of loss to LTF varied by center, and ranged from 9.8% to 100%. Independent predictors of loss to LTF were history of coronary artery disease or percutaneous coronary artery intervention (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.7), procedure type (OPEN, OR 1.4, 95% CI: 1.2-1.7; CEA, OR 1.2, 95% CI: 1.1-1.4; referent, EVAR), and discharge to rehab (OR 1.2, 95% CI: 1.1-1.4; referent, home). Center variation was the strongest determinant of loss to LTF with a model chi2 over 40 times as large as the second strongest determinant. CONCLUSIONS: LTF is central to outcome reporting and is vital to the success of any registry effort. In the VSGNE experience, center variation is the strongest predictor of loss to LTF, outweighing patient and procedural factors. Other predictors of loss to LTF included history of coronary revascularization, procedure type, no prior history of congestive heart failure, and discharge location. High performing centers likely have specific process measures that decrease loss to LTF. As the Society for Vascular Surgery Vascular Quality Initiative continues to roll out nationally, high performing centers in VSGNE should be studied to document and propagate best practices for minimizing loss to LTF.Source
Ann Vasc Surg. 2017 Apr;40:74-84. Epub 2016 Nov 27. Link to article on publisher's siteDOI
10.1016/j.avsg.2016.07.097Permanent Link to this Item
http://hdl.handle.net/20.500.14038/29055PubMed ID
27903469Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.avsg.2016.07.097