(IP233) Factors Associated with Loss to Follow Up After Operative Vascular Trauma

Objectives: Postoperative follow-up is essential for trauma patients undergoing vascular repairs or reconstructions to ensure patency of flow and prevent or identify complications, yet these patients are often lost to follow-up. Our study investigates the risk factors for loss to follow-up in vascular trauma patients, which are currently poorly understood.

Methods: Our retrospective cohort study included all patients who underwent operative treatment of a vascular injury at an urban level 1 trauma center between 2010 and 2024. Only residents of the same city as the trauma center were included. Patient identification, demographic information, and hospitalization characteristics were provided by the institutional trauma registry, while operative details and postoperative follow-up were acquired through chart review. Patients were considered lost to follow-up if they had no documented medical visits with the specialty that performed their vascular operation or if no vascular imaging was acquired after discharge. Association with follow-up was analyzed using unadjusted analysis followed by multivariable analysis for variables that were significant or trending towards significance on univariate analysis. Firth’s bias reduction method was used in multivariable analysis.

Results: Out of 355 patients included in our study (318 male, 37 female), 102 patients were lost to follow-up (29%). On multivariate analysis, having no medical insurance decreased the odds of follow-up (OR = 0.20, 95% CI 0.06-0.57, P < 0.01 for no insurance vs. commercial insurance). Factors that increased odds of follow-up included being a race other than black or white (OR = 28.84, 95% CI 2.91-3921.25, P < 0.01 other race vs. white), undergoing bypass (OR = 3.16, 95% CI 1.72-5.94, P < 0.01 for bypass vs. ligation), undergoing primary repair (OR = 2.81, 95% CI 1.48-5.44, P < 0.01 for primary repair vs. ligation), and being admitted by a surgical service other than trauma or orthopedics (OR = 4.18, 95% CI 1.21-22.02, P = 0.02 for other surgical vs. trauma). Injury severity score did not correlate with follow-up on univariate analysis.

Conclusions: Having no medical insurance decreased the odds of follow-up, while being a race other than black or white increased the odds of follow-up. Undergoing bypass, undergoing primary repair, and being admitted by a non-trauma service increased the odds of follow-up, suggesting that patients with more isolated vascular trauma are more likely to follow up than those with multisystem trauma. These risk-modifying factors can inform future management strategies aimed at improving post-operative follow-up in vascular trauma.