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Identification of Pre-Operative Risk Factors for Protracted Length of Stay After Elective EVAR
*Elizabeth G King1, *Denis Rybin2, *Gheorghe Doros2, Alik Farber1, *Jeffrey Kalish1, *Jeffrey J Siracuse1
1Boston Medical Center/Boston University School of Medicine, Boston, MA;2Boston University School of Medicine, Boston, MA
Objective(s)
A main advantage of endovascular aneurysm repair (EVAR) is shorter post-operative length of stay (LOS) compared to open repair. However, there is a subset of patients with pre-existing conditions that have a protracted LOS. Our aim was to identify pre-operative risk factors for prolonged postoperative LOS after elective EVAR.
Design
Retrospective review
Setting
ACS-NSQIP database from 2005-2013
Patients
All patients undergoing elective EVAR without adjunct procedures.
Interventions
N/A
Main Outcome Measure(s)
Preoperative risk factors associated with a protracted postoperative LOS.
Preoperative risk factors with significant association (P < 0.05) were used to develop a logistic regression model for protracted postoperative LOS.
Results
There were 21,769 patients that underwent elective EVAR with a median LOS of 2 days. The upper quartile (≥ 3) days was used for protracted LOS (median 5 days). Independent preoperative predictors of LOS were chronic renal insufficiency (OR 3.3, 95% CI 1.9-5.8), dependent functional status (OR 2.4, 95% CI 2.0-2.8), recent weight loss (OR 32.1, 95% CI 1.6-2.8), CHF (OR 1.8, 95% CI 1.4-2.3), elevated ASA class (OR 1.9, 95% CI 1.6-2.3), female gender (OR 1.7, 95% CI 1.6-1.9), and non-Caucasian race (OR 1.6, 95% CI 1.4-1.8). Furthermore, patients with a protracted postoperative LOS were more likely to be readmitted within 30 days (12.1% vs. 6.8%, P<.001).
Conclusions
Pre-operative demographics and co-morbidities represent significant risk factors for prolonged LOS after elective EVAR. These findings provide an important evidence basis for ongoing efforts to reduce healthcare spending by prospectively identifying high-risk patients. Preoperative targeting of these patients through multidisciplinary efforts may be able to reduce costs and improve outcomes.
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