Time until operation for elective endovascular aortic aneurysm repair in Canadian Vascular Centers using the Canadian Vascular Quality Initiative Registry.

Abstract

Objectives: Optimal timing for intervention for abdominal aortic aneurysms remains unclear. Given the increased rupture risk with larger aneurysms, timely intervention is critical. This study sought to examine endovascular aortic aneurysm repairs (EVAR) delays across Canadian centers, focusing on potential differences related to geography, sex and race.

Methods: The Vascular Quality Initiative (VQI) dataset was obtained for all patients who underwent elective EVAR for asymptomatic AAAs between January 11^th, 2016 and October 30^th, 2020 in 6 participating Canadian vascular centers. Delay was defined as the time between the date of preoperative imaging and the operative date. Univariate and multivariable analysis were performed to evaluate predictors of long delay.

Results: A total of 659 patients were included in the analysis. Geographic disparities were significant, with patients in Quebec more likely to experience delays exceeding 8 weeks compared to Ontario (OR = 4.5, 95% CI: 2.8-7.1, p < 0.001). Patients with shorter delays (≤ 8 weeks) were more likely to have an unrestricted functional status (88.0% vs. 81.9% for delay > 8 weeks, p = 0.030) and larger aneurysms (83.1% vs. 67.0% for delay > 8 weeks, p < 0.001). Perioperative and postoperative complications were similar across both groups.

Conclusion: Our study reveals significant disparities in the timing of elective EVAR cross Canadian centers, likely due to multifactorial causes. These findings highlight the need for targeted strategies to reduce delays and ensure equitable access to timely care. Future efforts should focus on improving healthcare system preparedness and addressing regional and demographic disparities.