Implementation of a Statewide Endovascular Aortic Aneurysm Surveillance Program Improves One-Year Follow-up and Survival

BACKGROUND National guidelines recommend long-term surveillance after endovascular AAA repair (EVAR) to monitor for endoleaks, graft migration or device failure. However, investigations have demonstrated that adherence to EVAR surveillance can vary greatly. Recently, the BMC2 Cardiovascular Consortium (BMC2) implemented a statewide performance metric, linked with financial reimbursement, designed to improved EVAR postoperative surveillance. The purpose of this study was to evaluate the impact of this statewide metric on EVAR follow-up and long-term endovascular outcomes. METHODS The BMC2 statewide cardiovascular consortium consisting of 36 hospitals was queried for patients who underwent EVAR between 2017-2023. Patient, hospital and operative risk factors were collected and analyzed based on the presence or absence of follow-up EVAR surveillance imaging. The primary outcome was adherence to recommended EVAR surveillance and the longitudinal change in percent of EVARs that obtained surveillance imaging. RESULTS A total of 5,742 patients underwent EVAR between 2017-2023. During the implementation of the EVAR surveillance metric, there was steady increase in the annual percentage of EVARs across the state who received postoperative 1-year EVAR surveillance imaging (26.46% in 2017 to 77.69% in 2023). On mixed logistic modeling, predictors of incomplete post-EVAR 1-year surveillance included emergent operation, length of stay and non-home discharge. For those patients that received appropriate EVAR surveillance imaging follow-up they displayed a higher number of repeat interventions (2.7% vs.1.6%; p<0.005) but had a decrease in one-year mortality (0.7% vs 10.6%; p<0.001) compared to those did not receive 1-year EVAR surveillance. CONCLUSIONS Incomplete imaging surveillance following EVAR remains high and predisposes patients to worse survival outcomes. Utilization of a performance metric both with associated financial incentive, within a statewide quality collaborative is a viable strategy that can have a significant impact on increasing EVAR surveillance and decreasing one-year mortality after endovascular AAA repair.