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在VA医院内血管腹腔大动脉动脉瘤修复后的成像监测依从性
Laura E Newton1,2, Aravind Ponukumati3, Gabrielle Zwain4
1Department of Surgical Services, Veterans Affairs Medical Center, White River Junction, Vermont.
JAMA network open
|April 24, 2025
概括
建议在内血管腹腔大动脉动脉瘤修复 (EVAR) 后每年进行成像监测,但随着时间的推移,退伍军人的坚持会降低. 诸如种族和残疾等因素会影响遵守,这表明需要以患者为中心的策略来改善后续护理.
科学领域:
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
- 医疗成像医学成像
背景情况:
- 准则建议在内血管腹腔大动脉瘤修复 (EVAR) 后进行年度成像监测.
- 退伍军人遵守这些监视指南的情况没有得到充分的证据.
- 了解监测模式对于优化患者长期治疗结果至关重要.
研究的目的:
- 在退伍军人群中描述EVAR后成像监视的模式和遵守.
- 为了确定与EVAR后低于最佳的监测遵守相关的因素.
主要方法:
- 在2000年至2023年期间接受EVAR的退伍军人的回顾性队列研究.
- 分析年度监测遵守情况,定义为EVAR后每年至少进行一次成像研究.
- 后勤回归用于识别与不良坚持相关的因素.
主要成果:
- 该研究包括27,792名退伍军人,平均随访时间为6.0年.
- 总体而言,年度监测遵守率为71.1%,但随着时间的推移显著下降 (第1年为90.0%,第4年为58.0%).
- 与较低坚持相关的因素包括白人种族,婚姻状况,与服务相关的残疾和较高的并发症得分.
结论:
- 在退伍军人中,EVAR后的监测遵守率最初很高,但在随后的几年中显著下降.
- 某些患者特征与较低的坚持有关,突出显示了潜在的差异.
- 结果可以为有针对性的干预提供信息,以改善长期监测合规性和患者护理.
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