New England Surgical Society

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Centers that Routinely Admit Postoperative EVARs to the ICU Have Similar Perioperative Outcomes with Longer Length of Stay Than Those That Do Not
*Thomas W Cheng1, Alik Farber1, *Scott R Levin1, *Mahmoud B Malas2, *Philip P Goodney3, *Virendra I Patel4, *Denis Rybin5, Jeffrey J Siracuse1
1Boston University School of Medicine, Boston, MA;2University of California San Diego, San Diego, CA;3Dartmouth-Hitchcock Medical Center, Lebahnon, NH;4Columbia University College of Physicians and Surgeons, New York City, NY;5Boston University School of Public Health, Boston, MA

Objectives: Intensive care unit (ICU) admission after endovascular aortic aneurysm repair (EVAR) varies across medical centers. We evaluated the association of postoperative ICU utilization with perioperative and long-term outcomes after EVARs. Design: The Vascular Quality Initiative (2003-2019) was reviewed for elective EVARs. Centers included were those categorized as routine ICU (rICU) if ≥80% of EVARs postoperatively admitted to the ICU or non-routine ICU (nrICU) if ≤20% of EVARs postoperatively admitted to the ICU. Patients admitted preoperatively or with same day discharge were excluded. Perioperative outcomes and survival were compared between patients at rICU and nrICU centers. Results: Of 35,617 patients undergoing EVARs, 15.3% were treated at 71 rICU centers and 84.7% at 200 nrICU centers. Overall, mean age was 73.4 years and 81.6% were male. Postoperative myocardial infarction, pulmonary complications, stroke, leg ischemia, and in-hospital mortality were similar between patients at rICU and nrICU centers (all P>.05). Postoperative length of stay (LOS) was prolonged for patients at rICU centers (mean) (2.2±3.6 vs. 2±4.2 days, P<.001). 1-year survival was similar between patients at rICU and nrICU centers, respectively, (94.9% vs. 95.4%, P=.085). Patients at rICU compared to those at nrICU centers had similar risk for 1-year mortality (HR 1.15, 95% CI .99-1.34, P=.076), but longer postoperative LOS (MR 1.1, 95% CI 1.08-1.13, P<.001) Conclusion: Routine ICU utilization after EVAR was associated with prolonged postoperative LOS without improved perioperative, long-term morbidity, or mortality. Updated care pathways to include postoperative admission to lower acuity care units may reduce costs without compromising patient care.


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