Survival following abdominal aortic aneurysm repair in North Queensland is not associated with remoteness of place of residence

Golledge, Jonathan, Drovandi, Aaron, Velu, Ramesh, Quigley, Frank, and Moxon, Joseph (2020) Survival following abdominal aortic aneurysm repair in North Queensland is not associated with remoteness of place of residence. PLoS ONE, 15 (11). e0241802.

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Abstract

Objective: To assess whether survival and clinical events following elective abdominal aortic aneurysm (AAA) repair were associated with remoteness of residence in North Queensland, Australia.

Methods: This retrospective cohort study included participants undergoing elective AAA repair between February 2002 and April 2020 at two hospitals in Townsville, North Queensland, Australia. Outcomes were all-cause survival and AAA-related events, defined as requirement for repeat AAA repair or AAA-related mortality. Remoteness of participant's place of residence was assessed by the Modified Monash Model classifications and estimated distance from the participants' home to the tertiary vascular centre. Cox proportional hazard analysis examined the association of remoteness with outcome.

Results: The study included 526 participants undergoing elective repair by open (n = 204) or endovascular (n = 322) surgery. Fifty-four (10.2%) participants had a place of residence at a remote or very remote location. Participants' were followed for a median of 5.2 (inter-quartile range 2.5-8.3) years, during which time there were 252 (47.9%) deaths. Survival was not associated with either measure of remoteness. Fifty (9.5%) participants had at least one AAA-related event, including 30 (5.7%) that underwent at least one repeat AAA surgery and 23 (4.4%) that had AAA-related mortality. AAA-related events were more common in participants resident in the most remote areas (adjusted hazard ratio 2.83, 95% confidence intervals 1.40, 5.70) but not associated with distance from the participants' residence to the tertiary vascular centre.

Conclusions: The current study found that participants living in more remote locations were more likely to have AAA-related events but had no increased mortality following AAA surgery. The findings emphasize the need for careful follow-up after AAA surgery. Further studies are needed to examine the generalisability of the findings.

Item ID: 67089
Item Type: Article (Research - C1)
ISSN: 1932-6203
Keywords: abdominal aortic aneurysm; AAA; AAA repair; abdominal aortic aneurysm repair; North Queensland; remoteness; residence; surgery
Copyright Information: Copyright: © 2020 Golledge et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funders: National Health and Medical Research Council (NHMRC), James Cook University (JCU), Queensland Government (QG)
Projects and Grants: NHMRC 1063476, NHMRC 1000967, NHMRC 1117061, QG Senior Clinical Research Fellowship, QG Advance Queensland Fellowship
Date Deposited: 09 Mar 2021 03:02
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210399 Aboriginal and Torres Strait Islander health not elsewhere classified @ 50%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
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