Automatic 1-year follow-up appointment creation and reminders can improve long-term follow-up after carotid revascularization

David P Stonko; Shira Mohammed; Diane Skojec; Joanna Rutkowski; Diana Call; Katherine G Verdi; Lillian L Tsai; James H Black 3rd; Bruce A Perler; Christopher J Abularrage; Ying Wei Lum; Maya J Salameh; Caitlin W Hicks

doi:10.1016/j.amjsurg.2023.09.032

Automatic 1-year follow-up appointment creation and reminders can improve long-term follow-up after carotid revascularization

Am J Surg. 2024 Jan:227:57-62. doi: 10.1016/j.amjsurg.2023.09.032. Epub 2023 Sep 27.

Authors

Affiliations

¹ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: dstonko1@jhmi.edu.
² Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: smoham14@jhmi.edu.
³ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: dskojec1@jhmi.edu.
⁴ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: jrutkow1@jhmi.edu.
⁵ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: dcall@jhmi.edu.
⁶ Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: kgiuliano@jhmi.edu.
⁷ Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: ltsai2@jhmi.edu.
⁸ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: jhblack@jhmi.edu.
⁹ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: bperler@jhmi.edu.
¹⁰ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: cabular1@jhmi.edu.
¹¹ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: ylum1@jhmi.edu.
¹² Johns Hopkins Center for Vascular Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD, USA; Cardiovascular Specialist of Frederick, Frederick, MD, USA. Electronic address: msalame1@jhmi.edu.
¹³ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: chicks11@jhmi.edu.

PMID: 37827870
PMCID: PMC10797636 (available on 2025-01-01)
DOI: 10.1016/j.amjsurg.2023.09.032

Abstract

Background: Long-term follow-up (LTFU) following carotid revascularization is important for post-surgical care, stroke risk optimization and post-market surveillance of new technologies.

Methods: We instituted a quality improvement project to improve LTFU rates for carotid revascularizations (primary outcome) by scheduling perioperative and one-year follow-up appointments at time of surgery discharge. A temporal trends analysis (Q1 2019 through Q1 2022), multivariable regression, and interrupted time series (ITS) were performed to compare pre-post intervention LTFU rates.

Results: 269 consecutive patients were included (151 pre-intervention, 118 post-intervention; mean 71 ± 12 years-old, 39% female, 77% White). The overall LTFU rate improved (64.9%-78.8%; P = 0.013) after the intervention. After controlling for patient factors, procedures performed after the intervention were associated with increased odds of being seen for 1-year follow-up (OR: 2.2 95%CI: 1.2-4.0). Quarterly ITS analysis corroborated this relationship (P = 0.01).

Conclusions: Time-of-surgery appointment creation and automated patient reminders can improve LTFU rates following carotid revascularizations.

Keywords: CEA; Carotid revascularization; Quality improvement; TCAR; VQI.

MeSH terms

Aged
Aged, 80 and over
Carotid Stenosis* / surgery
Endarterectomy, Carotid*
Endovascular Procedures*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Stroke* / complications
Treatment Outcome

Grants and funding

K23 DK124515/DK/NIDDK NIH HHS/United States