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The Effect Of Rurality On Aneurysm Presentation And Post-operative Follow-up After Endovascular Aortic Aneurysm Repair
Sashi Inkollu, MD1, Paul Rothenberg, MD
1, Santiago Lopez, BS
1, Erika T. Beidelman, MA
2, Corey A. Kalbaugh, PhD, MS
2, Pamela Zimmerman, MD
1, Samantha D. Minc, MD, MPH
1;
1West Virginia University, Morgantown, WV, USA,
2Indiana University, Bloomington, IN, USA
OBJECTIVEPatients lost to follow-up after endovascular repair of abdominal aortic aneurysm (EVAR) have worse outcomes. Rural patients have significant barriers to care and may present for surgery with larger aneurysms and be more likely to be lost to follow-up. The purpose of this study was to assess the effects of rurality on clinical presentation of abdominal aortic aneurysms (AAA) and follow-up after EVAR.
METHODSThe Vascular Quality Initiative (VQI) EVAR module (2003-2021) was used for analyses (n=62,503). Patients were categorized as residing in an urban or rural area using Rural-Urban Commuting Area (RUCA) codes. Univariate analyses were performed to describe differences in sociodemographic, intraoperative, and follow-up factors. We fit unadjusted and adjusted logistic regression models to assess the association between rurality and aneurysm size, symptomatic presentation, adverse cardiovascular events, death, loss to follow-up, and follow-up type.
RESULTSSeventy-nine percent (n=49,372) of patients were classified as urban and 21% (n=13,131) as rural with several significantly different demographic variables (Figure 1). On multivariable analyses, residing in a rural area was significantly associated with 9% higher odds of presenting with a larger AAA (p<0.001), 18% higher odds of having a symptomatic/ruptured aneurysm (p<0.001), 14% lower odds of having follow-up imaging (p<0.001), and 10% lower odds of having in-person follow-up (p<0.001). Although results did not achieve statistical significance, residing in a rural area was associated with an 8% increase in odds of being lost to follow-up compared to residing in an urban area (95% CI 1.00-1.16, p=0.054).
CONCLUSIONSRural patients had significantly higher odds of presenting with symptomatic/ruptured AAA and at larger sizes than their urban counterparts. Disparities in loss to follow-up did not achieve statistical significance, however among patients that did follow-up, rural patients had lower odds of being seen in person or having imaging. Additional resources to improve AAA screening, access to repair, and a focus on community-level interventions to optimize follow-up in rural populations is merited.
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