Gaps in preoperative surveillance and rupture of abdominal aortic aneurysms among Medicare beneficiaries

Matthew Mell, Laurence C. Baker, Ronald L. Dalman, Mark A. Hlatky

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective Screening and surveillance are recommended in the management of small abdominal aortic aneurysms (AAAs). Gaps in surveillance after early diagnosis may lead to unrecognized AAA growth, rupture, and death. This study investigates the frequency and predictors of rupture of previously diagnosed AAAs. Methods Data were extracted from Medicare claims for patients who underwent AAA repair between 2006 and 2009. Relevant preoperative abdominal imaging exams were tabulated up to 5 years prior to AAA repair. Repair for ruptured AAAs was compared with repair for intact AAAs for those with an early diagnosis of an AAA, defined as having received imaging at least 6 months prior to surgery. Gaps in surveillance were defined as no image within 1 year of surgery or no imaging for more than a 2-year time span after the initial image. Logistic regression was used to examine independent predictors of rupture despite early diagnosis. Results A total of 9298 patients had repair after early diagnosis, with rupture occurring in 441 (4.7%). Those with ruptured AAAs were older (80.2 ± 6.9 vs 77.6 ± 6.2 years; P <.001), received fewer images prior to repair (5.7 ± 4.1 vs 6.5 ± 3.5; P =.001), were less likely to be treated in a high-volume hospital (45.4% vs 59.5%; P <.001), and were more likely to have had gaps in surveillance (47.4% vs 11.8%; P <.001) compared with those receiving repair for intact AAAs. After adjusting for medical comorbidities, gaps in surveillance remained the largest predictor of rupture in a multivariate analysis (odds ratio, 5.82; 95% confidence interval, 4.64-7.31; P <.001). Conclusions Despite previous diagnosis of AAA, many patients experience rupture prior to repair. Improved mechanisms for surveillance are needed to prevent rupture and ensure timely repair for patients with AAAs.

Original languageEnglish (US)
Pages (from-to)583-588
Number of pages6
JournalJournal of Vascular Surgery
Volume59
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

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Abdominal Aortic Aneurysm
Medicare
Rupture
Early Diagnosis
Aortic Rupture
High-Volume Hospitals
Comorbidity
Multivariate Analysis
Logistic Models
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gaps in preoperative surveillance and rupture of abdominal aortic aneurysms among Medicare beneficiaries. / Mell, Matthew; Baker, Laurence C.; Dalman, Ronald L.; Hlatky, Mark A.

In: Journal of Vascular Surgery, Vol. 59, No. 3, 01.03.2014, p. 583-588.

Research output: Contribution to journalArticle

Mell, Matthew ; Baker, Laurence C. ; Dalman, Ronald L. ; Hlatky, Mark A. / Gaps in preoperative surveillance and rupture of abdominal aortic aneurysms among Medicare beneficiaries. In: Journal of Vascular Surgery. 2014 ; Vol. 59, No. 3. pp. 583-588.
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abstract = "Objective Screening and surveillance are recommended in the management of small abdominal aortic aneurysms (AAAs). Gaps in surveillance after early diagnosis may lead to unrecognized AAA growth, rupture, and death. This study investigates the frequency and predictors of rupture of previously diagnosed AAAs. Methods Data were extracted from Medicare claims for patients who underwent AAA repair between 2006 and 2009. Relevant preoperative abdominal imaging exams were tabulated up to 5 years prior to AAA repair. Repair for ruptured AAAs was compared with repair for intact AAAs for those with an early diagnosis of an AAA, defined as having received imaging at least 6 months prior to surgery. Gaps in surveillance were defined as no image within 1 year of surgery or no imaging for more than a 2-year time span after the initial image. Logistic regression was used to examine independent predictors of rupture despite early diagnosis. Results A total of 9298 patients had repair after early diagnosis, with rupture occurring in 441 (4.7{\%}). Those with ruptured AAAs were older (80.2 ± 6.9 vs 77.6 ± 6.2 years; P <.001), received fewer images prior to repair (5.7 ± 4.1 vs 6.5 ± 3.5; P =.001), were less likely to be treated in a high-volume hospital (45.4{\%} vs 59.5{\%}; P <.001), and were more likely to have had gaps in surveillance (47.4{\%} vs 11.8{\%}; P <.001) compared with those receiving repair for intact AAAs. After adjusting for medical comorbidities, gaps in surveillance remained the largest predictor of rupture in a multivariate analysis (odds ratio, 5.82; 95{\%} confidence interval, 4.64-7.31; P <.001). Conclusions Despite previous diagnosis of AAA, many patients experience rupture prior to repair. Improved mechanisms for surveillance are needed to prevent rupture and ensure timely repair for patients with AAAs.",
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N2 - Objective Screening and surveillance are recommended in the management of small abdominal aortic aneurysms (AAAs). Gaps in surveillance after early diagnosis may lead to unrecognized AAA growth, rupture, and death. This study investigates the frequency and predictors of rupture of previously diagnosed AAAs. Methods Data were extracted from Medicare claims for patients who underwent AAA repair between 2006 and 2009. Relevant preoperative abdominal imaging exams were tabulated up to 5 years prior to AAA repair. Repair for ruptured AAAs was compared with repair for intact AAAs for those with an early diagnosis of an AAA, defined as having received imaging at least 6 months prior to surgery. Gaps in surveillance were defined as no image within 1 year of surgery or no imaging for more than a 2-year time span after the initial image. Logistic regression was used to examine independent predictors of rupture despite early diagnosis. Results A total of 9298 patients had repair after early diagnosis, with rupture occurring in 441 (4.7%). Those with ruptured AAAs were older (80.2 ± 6.9 vs 77.6 ± 6.2 years; P <.001), received fewer images prior to repair (5.7 ± 4.1 vs 6.5 ± 3.5; P =.001), were less likely to be treated in a high-volume hospital (45.4% vs 59.5%; P <.001), and were more likely to have had gaps in surveillance (47.4% vs 11.8%; P <.001) compared with those receiving repair for intact AAAs. After adjusting for medical comorbidities, gaps in surveillance remained the largest predictor of rupture in a multivariate analysis (odds ratio, 5.82; 95% confidence interval, 4.64-7.31; P <.001). Conclusions Despite previous diagnosis of AAA, many patients experience rupture prior to repair. Improved mechanisms for surveillance are needed to prevent rupture and ensure timely repair for patients with AAAs.

AB - Objective Screening and surveillance are recommended in the management of small abdominal aortic aneurysms (AAAs). Gaps in surveillance after early diagnosis may lead to unrecognized AAA growth, rupture, and death. This study investigates the frequency and predictors of rupture of previously diagnosed AAAs. Methods Data were extracted from Medicare claims for patients who underwent AAA repair between 2006 and 2009. Relevant preoperative abdominal imaging exams were tabulated up to 5 years prior to AAA repair. Repair for ruptured AAAs was compared with repair for intact AAAs for those with an early diagnosis of an AAA, defined as having received imaging at least 6 months prior to surgery. Gaps in surveillance were defined as no image within 1 year of surgery or no imaging for more than a 2-year time span after the initial image. Logistic regression was used to examine independent predictors of rupture despite early diagnosis. Results A total of 9298 patients had repair after early diagnosis, with rupture occurring in 441 (4.7%). Those with ruptured AAAs were older (80.2 ± 6.9 vs 77.6 ± 6.2 years; P <.001), received fewer images prior to repair (5.7 ± 4.1 vs 6.5 ± 3.5; P =.001), were less likely to be treated in a high-volume hospital (45.4% vs 59.5%; P <.001), and were more likely to have had gaps in surveillance (47.4% vs 11.8%; P <.001) compared with those receiving repair for intact AAAs. After adjusting for medical comorbidities, gaps in surveillance remained the largest predictor of rupture in a multivariate analysis (odds ratio, 5.82; 95% confidence interval, 4.64-7.31; P <.001). Conclusions Despite previous diagnosis of AAA, many patients experience rupture prior to repair. Improved mechanisms for surveillance are needed to prevent rupture and ensure timely repair for patients with AAAs.

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