Aortic aneurysms: A silent threat, but a Michigan alliance is fighting back! Through a collaborative effort across the state, hospitals are dramatically improving patient care following a critical surgery. This initiative focuses on a crucial aspect of post-operative care: follow-up imaging.
The study reveals a significant shift in patient care. The rate of follow-up imaging after endovascular aneurysm repair (EVAR) soared from roughly 28% in 2017 to nearly 80% by 2023. This is a massive leap!
But why is this so important? Patients who received these follow-up scans experienced a remarkable reduction in mortality. They had a nearly 60% lower chance of dying within a year of surgery, after accounting for other health issues.
These findings were published in Circulation: Population Health and Outcomes.
"EVAR is now more common than open surgery, yet as many as 57% of patients were missing essential follow up imaging," explains Dr. Frank M. Davis, the study's first author. "This partnership allowed us to see sweeping improvements in surveillance imaging, which will help clinicians detect early problems that can lead to device failure or future, threatening complications such as aortic rupture."
Current guidelines from the Society for Vascular Surgeons recommend annual lifelong surveillance after EVAR using CT scans or ultrasound.
The program involved over 30 hospitals and offered financial incentives to encourage surveillance imaging in the year following EVAR. This initiative was organized through the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).
The BMC2, based at Michigan Medicine, is a network of hospitals across Michigan that use collected data to improve patient care and outcomes.
Before this initiative, the rate of EVAR surveillance imaging varied wildly across Michigan hospitals, ranging from 3.7% at smaller hospitals to 62.5% at larger ones. The initiative led to improvements across the board, regardless of the hospital's size or performance. By 2023, 95% of participating hospitals had EVAR surveillance rates above 60%.
"The long-term success of a surveillance program like this depends on identifying processes at each participating hospital that can be built into routine practice, making them easier for health care teams to sustain," says Dr. Nicholas Osborne, a senior author.
Each year, around 200,000 Americans are affected by abdominal aortic aneurysms.
Around 14% of patients who have EVAR require a second procedure within four to five years and less than 2% experience late aortic rupture as a complication.
Here's where it gets controversial... Patients who received surveillance imaging during the study period actually had a higher number of repeat interventions than those who did not get imaging. However, their mortality rate was significantly lower.
Past studies have yielded mixed results on whether follow-up imaging truly reduces the risk of death after EVAR. Researchers plan to use BMC2 data to assess mortality risk after 5 and 10 years of surveillance.
"This study demonstrates the importance of BMC2, as implementation of quality programs across the state of Michigan care lead to substantial improvement in care for patients including those who have aortic surgery," Davis said.
Additional authors include Jeremy Albright, Ph.D., Brennan Callow, Loay Kobbani, M.D., Tamer Boules, M.D., Hue Thai, M.D., and Nicolas Mouawad, M.D.
Funding for the study was provided by a VA Career Development grant and support for BMC2 was provided by Blue Cross Blue Shield of Michigan and Blue Care Network.
What do you think? Does this study highlight the importance of proactive post-operative care? Do you think financial incentives are a good way to improve healthcare practices? Share your thoughts in the comments below!
