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Are current follow-up intervals justified in patients with non-emergent aortic surgeries?
Joseph Kletzer1,2, Tim Berger1,2, Stoyan Kondov1,2
1Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany.
Insights
The first 6-month follow-up after aortic surgery is crucial for detecting complications. Skipping this visit risks missing aortic events, potentially harming patients and necessitating reintervention.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Medical Imaging and Diagnostics
Background:
- Surveillance protocols post-aortic treatment lack definitive evidence.
- Clinical relevance of the initial 6-month follow-up visit requires analysis.
Purpose of the Study:
- To analyze the clinical significance of the first follow-up visit at 6 months post-aortic treatment.
- To determine the impact of skipping the 6-month follow-up on patient outcomes.
Main Methods:
- Retrospective analysis of 464 patients treated for non-emergent aortic pathologies (Jan 2018 - Dec 2019).
- Investigation of aortic events including death, reintervention, endoleaks, aneurysms, and diameter progression.
- Application of a discrete-time non-homogeneous Markov Chain Model to assess the risk of missed follow-ups.
Main Results:
- At 6 months, 15.31% of endovascular patients experienced aortic events, versus 0.59% of open surgery patients.
- Markov model indicated 4.75% of patients experienced events, reintervention, or death by 6 months.
- 60 patients skipping the 6-month visit could lead to unnoticed reintervention indications; 24 for unnoticed complications.
Conclusions:
- The 6-month follow-up is vital after elective endovascular or open aortic surgery.
- Extended intervals risk a significant increase in missed aortic events.
- Balancing follow-up costs/radiation with early intervention benefits requires further research.
Objectives:
Evidence for different surveillance protocols following aortic treatment is still lacking. The aim of this study was to analyse the clinical relevance of a first follow-up visit after 6 months.
Methods:
Between January 2018 and December 2019, 464 patients treated for non-emergent aortic pathologies were retrospectively analysed. The incidence of aortic events during follow-up (ie, death, reintervention, endoleaks, anastomotic/new aneurysms and diameter progression over time) was investigated. A discrete-time non-homogeneous Markov Chain Model was used to analyse the data and to arrive at the number of skipped 6-month follow-up visits needed to harm a patient.
Results:
After 6 months, 2 (1.77%) patients had died, 15 (15.31%) patients suffered from aortic events and a total of 4 (3.67%) patients had undergone reintervention after endovascular surgery, compared to 0 deaths, 2 (0.59%) patients with aortic events and 5 (1.48%) reinterventions after open surgery. In our Markov Chain Model, after 6 months, 4.75% of patients showed aortic events, received a reintervention or died. Sixty patients would need to skip their 6-month follow-up visit for one indication for reintervention to go unnoticed. Only 24 would need to skip it for one complication to go by unnoticed. This number is 55 after open surgery and 9 after endovascular surgery.
Conclusions:
After elective endovascular or open aortic surgery without immediate in-hospital postoperative aortic events, the first follow-up visit after 6 months is important. Extending the first interval to longer time periods might lead to a considerable increase in missed aortic events. The cost and radiation exposure of frequent follow-ups must be balanced against the benefits of early preventative aortic interventions, warranting further research.
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