Room for improvement in patient compliance during peripheral vascular interventions

Background

For patients receiving procedural sedation and analgesia (PSA), patient cooperation is crucial, because patients remain continuously aware of operating room activity and can be asked to perform tasks, such as prolonged breath-holds. This survey aimed to collect information on patient compliance with on-table instructions and its relation to periprocedural outcomes from surgeons nationwide performing peripheral vascular interventions (PVIs) under PSA.

Methods

A nine-question online survey was sent to 383 vascular surgeons (including both vascular surgery attendings and trainees) across the United States through REDCap from August 30 to September 21, 2021, with responses closed on October 30, 2021. The survey response was analyzed with descriptive statistics.

Results

There were 83 (21.6%) vascular surgeons who responded to the survey, of who, 67 (80.7%) were attending vascular surgeons and 16 (19.3%) were vascular surgery trainees. Forty-one respondents (49.4%) performed 11 to 20 PVI cases under PSA every month, and 31 (41.0%) respondents performed 1 to 10 PVI cases under PSA every month. Forty-one respondents (49.4%) reported that in 1% to 10% of their cases, additional contrast and/or radiation was administered because patient moved on the table or did not cooperate with breath-holds; 25 (30.1%) reported that this occurred in 11% to 20% of their cases, 12 (14.5%) reported that this occurred in 21% to 50% of their cases, and 4 (4.8%) reported that this occurred in >50% of their cases. In such cases, the majority of respondents reported a 1% to 10% increase in contrast volume (59.0%), radiation dosage (62.7%), sedative/analgesia administration (46.3%), and procedural time (54.9%). Of cases being converted to general anesthesia owing to inadequate patient cooperation, 35 (42.2%) respondents reported between 1 and 5 cases per month and 3 (3.6%) respondents reported between 6 and 10 cases per month. Of cases being aborted owing to inadequate patient cooperation, 25 respondents (30.1%) reported between 1 and 5 cases per month, and 1 (1.2%) respondent reported between 6 and 10 cases per month.

Conclusions

A significant fraction of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration, and procedural time owing to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.