title: Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair.
abstract: OBJECTIVE
  Integral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.
  
  
  METHODS
  Retrospective analysis of 179 consecutive elective EVAR cases [2008-2013] was performed. 167 patients were male, with the age range of 50-95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.
  
  
  RESULTS
  Fifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).
  
  
  CONCLUSIONS
  Compliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.
authors.affiliation: Unit of Cardiac Vascular and Thoracic Surgery (CV&T), Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK. deangodfrey@yahoo.co.uk.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Godfrey
authors.affiliation: Unit of Cardiac Vascular and Thoracic Surgery (CV&T), Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK. a.morbi@soton.ac.uk.|University of Southampton, Southampton, Hampshire, SO16 6YD, UK. a.morbi@soton.ac.uk.
authors.forename: Abigail H M
authors.initials: AH
authors.lastname: Morbi
authors.affiliation: Unit of Cardiac Vascular and Thoracic Surgery (CV&T), Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK. ian.nordon@uhs.nhs.uk.|University of Southampton, Southampton, Hampshire, SO16 6YD, UK. ian.nordon@uhs.nhs.uk.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Nordon
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: AAA; Compliance; EVAR; Endovascular aneurysm repair; Outcomes; Surveillance