The influence of incidental abdominal aortic aneurysm monitoring on patient outcomes Carl van Walraven, MD, MSc, FRCPC, Jenna Wong, MSc, Kareem Morant,

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Presentation transcript:

The influence of incidental abdominal aortic aneurysm monitoring on patient outcomes Carl van Walraven, MD, MSc, FRCPC, Jenna Wong, MSc, Kareem Morant, MD, Alison Jennings, MA, Peter C. Austin, PhD, Prasad Jetty, MD, MSc, FRCSC, Alan J. Forster, MD, MSc, FRCPC Journal of Vascular Surgery Volume 54, Issue 5, Pages 1290-1297.e2 (November 2011) DOI: 10.1016/j.jvs.2011.05.045 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Creation of study cohort. AAA, Abdominal aortic aneurysm. Journal of Vascular Surgery 2011 54, 1290-1297.e2DOI: (10.1016/j.jvs.2011.05.045) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Quantifying incidental abdominal aortic aneurysm (AAA) monitoring completeness over time. This figure illustrates how we quantified incidental AAA monitoring completeness as the “consecutive number of months without monitoring.” In this example, the AAA has a diameter of 3.4 cm when it is discovered incidentally. Guidelines (Appendix C, online only) recommend that abdominal imaging be repeated in 3 years (Line A). The patient illustrated above did not have repeat imaging until year 5 and was therefore unmonitored between months 36 and 60. During this time, their consecutive months without monitoring increased from 0 to 24 (bottom part of graph). This variable was included in our survival (Cox) model as a time-dependent covariate to measure the association of incidental AAA monitoring with time to the outcomes (elective AAA repair and death). We used this methodology in a previous study about incidental AAA monitoring.8 Journal of Vascular Surgery 2011 54, 1290-1297.e2DOI: (10.1016/j.jvs.2011.05.045) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 Completeness of incidental abdominal aortic aneurysm (AAA) monitoring over time. This figure presents the median (heavy line) and both 25th and 75th percentiles (dotted lines) for consecutive number of years without radiological monitoring of incidental AAAs in the study cohort. Journal of Vascular Surgery 2011 54, 1290-1297.e2DOI: (10.1016/j.jvs.2011.05.045) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 Independent association of consecutive years without abdominal aortic aneurysm (AAA) monitoring with time to elective AAA repair and time to all-cause death. The vertical axis presents the adjusted hazard ratio for the association of consecutive years without monitoring (horizontal axis) with time to elective AAA repair (gray line) and time to all-cause death (black line). The hazard ratio indicates the adjusted relative hazard of an event for someone with that amount of years without monitoring compared with someone whose incidental AAA is being radiologically monitored. For example, the hazard of dying for a person whose AAA went without radiological monitoring for 1 year is three times that someone whose radiological monitoring was complete. These values are adjusted for all other factors presented in Table II. With time to death as the outcome, consecutive years without monitoring was expressed as consecutive months without monitoring-2 + consecutive months without monitoring-2 * log (consecutive months without monitoring). With time to elective repair as the outcome, consecutive years without monitoring was expressed as consecutive months without monitoring + consecutive months without monitoring * log (consecutive months without monitoring). Journal of Vascular Surgery 2011 54, 1290-1297.e2DOI: (10.1016/j.jvs.2011.05.045) Copyright © 2011 Society for Vascular Surgery Terms and Conditions