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Patient Compliance During Peripheral Vascular Interventions: Room For Improvement?
C. Y. Maximilian Png1, Laura T. Boitano, MD
2, Jordan R. Stern, MD
3, Sunita D. Srivastava, MD
1, Matthew J. Eagleton, MD
1, Abhisekh Mohapatra, MD
1, Anahita Dua, MD
1.
1Massachusetts General Hospital, Boston, MA, USA,
2UMass Memorial, Worchester, MA, USA,
3Stanford Medicine, Stanford, CA, USA.
OBJECTIVES: For patients undergoing Procedural Sedation and Analgesia (PSA) in contrast to General Anesthesia, intraprocedural patient cooperation is crucial as patients remain continuously aware of operating room activity and are asked to perform tasks such as prolonged breath-holds. This survey aimed to collect information on patient cooperation and its relation to periprocedural outcomes from surgeons nationwide performing peripheral vascular interventions (PVI) under PSA.
METHODS: A 9-question online survey (Fig1) was sent to 383 vascular surgeons across the United States through REDCap from August 30 to September 21, 2021. The survey response was analyzed with descriptive statistics.
RESULTS: 83 (21.6%) vascular surgeons responded to the survey, of which 67 (80.7%) were attending vascular surgeons and 16 (19.3%) were vascular surgery trainees. 41 (49.4%) respondents performed 11-20 PVI cases under PSA every month, while 31 (41.0%) respondents performed 1-10 PVI cases under PSA every month. 41 (49.4%) respondents reported that in 1-10% of their cases, additional contrast and/or radiation was administered because patient moved on the table or did not cooperate with breath holds; 25 (30.1%) reported that this occurred in 11-20% of their cases, 12 (14.5%) reported that this occurred in 21-50% of their cases and 4 (4.8%) reported that this occurred in over 50% of their cases. In such cases, the majority of respondents reported a 1-10% increase in contrast volume (59.0%), radiation dosage (62.7%), sedative/analgesia administration (46.3%) and procedural time (54.9%).
Of cases being converted to general anesthesia due to inadequate patient cooperation, 35 (42.2%) respondents reported between 1-5 per month, and 3 (3.6%) respondents reported between 6-10 per month. Of cases being converted aborted due to inadequate patient cooperation, 25 (30.1%) respondents reported between 1-5 per month, and 1 (1.2%) respondents reported between 6-10 per month.
CONCLUSIONS: A significant portion of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration and procedural time due to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.
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Of cases being converted to general anesthesia due to inadequate patient cooperation, 35 (42.2%) respondents reported between 1-5 per month, and 3 (3.6%) respondents reported between 6-10 per month. Of cases being converted aborted due to inadequate patient cooperation, 25 (30.1%) respondents reported between 1-5 per month, and 1 (1.2%) respondents reported between 6-10 per month. CONCLUSIONS: A significant portion of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration and procedural time due to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.
