Geographic disparities in perioperative and mid-term outcomes after elective infrarenal endovascular aneurysm repair
Notice bibliographique
Résumé
Objective This study aimed to assess the impact of geographic location on mid-term postoperative outcomes after EVAR across 4 Canadian tertiary care institutions. We hypothesized that patients from rural or non-local areas may experience worse perioperative outcomes because of loss to follow-up, care transfers, and suboptimal surveillance. These factors could contribute to increased non-index readmissions and higher mortality rates following elective endovascular aneurysm repair (EVAR). Methods Elective infrarenal EVAR patients from four Canadian tertiary care institutions were assessed through a retrospective analysis of the Vascular Quality Initiative (VQI) database, stratified by rural versus urban postal codes. A subgroup analysis was also conducted using a 10-year retrospective dataset from Toronto General Hospital (TGH) and the VQI to evaluate EVAR outcomes based on patient geography. Primary outcomes included differences in loss to follow-up, overall survival, and reintervention-free survival. Secondary outcomes included differences in baseline characteristics, perioperative outcomes, and imaging surveillance. Statistical analyses consisted of t-tests for continuous variables, chi-square tests for categorical variables, and Kaplan-Meier survival analysis with log-rank tests. Results Elective EVAR outcomes from four Canadian hospitals (n=1,342 patients) were analyzed by rural versus urban status. Rural patients demonstrated higher postoperative imaging rates but were more likely to be lost to follow-up. Aggregate data revealed a survival advantage for urban patients at 12 months postoperatively. A subgroup analysis from a single tertiary care institution included 491 patients who underwent elective infrarenal EVAR. Patients were categorized by postal code as local versus non-local (80.9% and 19.1%, respectively) and urban versus rural (94.9% and 5.1%, respectively). The median follow-up duration was 32 months (IQR 51). Local and urban patients had significantly higher rates of follow-up within the first two months (local: 84.6% vs. non-local: 57.4%, p<0.001; urban: 80.2% vs. rural: 64.0%, p=0.050) and more frequent imaging between 6 and 12 months (local: 69.5% vs. non-local: 43.6%, p<0.001; urban: 65.9% vs. rural: 40.0%, p=0.008). However, survival analysis did not demonstrate significant differences in estimated mean postoperative survival between groups (urban: 9.19 years vs. rural: 9.87 years, p=0.162; local: 9.15 years vs. non-local: 9.72 years, p=0.219). Conclusions At the national level, four Canadian VQI centres demonstrated higher rates of loss to follow-up and decreased one-year survival among patients from rural communities. In contrast, a subgroup analysis from our institution revealed that rural and non-local patients received fewer follow-up appointments and underwent less postoperative imaging; however, no significant differences in mortality or reintervention were observed. The influence of geographic distance and rurality status on follow-up and imaging highlights a potential vulnerability to aneurysm-related mortality, warranting further investigation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».