Abstract
ObjectiveEndovascular aortic aneurysm repair (EVAR) has increasingly replaced open aortic surgery for treatment of abdominal aortic aneurysms (AAA). One of the key advantages of EVAR is the reduced length of intensive care unit (ICU) stay and hospital stay. This study aimed to identify the risk factors associated with increased ICU length of stay (LOS) after EVAR.MethodsThe American College of Surgeons (ACS-NSQIP) database for the year 2013 was used. All patients who underwent EVAR were divided into two groups: ICU LOS <1 day vs. ≥1 day. Preoperative, intraoperative, and postoperative factors were compared between these two groups utilizing bivariate logistic regression analysis. Multivariable logistic regression analysis was then used to identify factors that were independently associated with ICU LOS ≥1 day after EVAR.ResultsA total of 2,468 patients (18.7% females, 81.3% males) were identified. Group 1 (ICU LOS <1 day) = 1,535 patients and Group 2 (ICU LOS ≥1 day) = 933 patients. Multivariable analysis identified the following factors to be associated with ICU LOS ≥1 day: ruptured AAA (OR 3.88, CI 1.97-7.65), the American Society of Anesthesiology (ASA) score of 4-5 (OR 2.82, CI 1.50-5.31), operative time ≥180 minutes (OR 2.10, CI 1.51-2.93), bilateral groin cut down (OR 1.37, CI 1.10-1.71), juxta-renal AAA (OR 1.65, CI 1.16-2.35), renal artery stent (OR 2.13, CI 1.42-3.21), aortic stent (OR 2.39, CI 1.60-3.55), emergency surgery (OR 2.56, CI 1.94-3.38), need for blood transfusion (OR 3.11, CI 2.08-4.65) and postoperative pneumonia (OR 7.04, CI 1.95-25.45).ConclusionVariables identified above can be used to predict the cohort of EVAR patients which will likely require ICU for ≥1 day. Development of postoperative pneumonia is associated with a 7.04 times increase in ICU LOS ≥1 day.
Highlights
The past two decades have seen a revolution in the surgical treatment of abdominal aortic aneurysms (AAA)
Multivariable analysis identified the following factors to be associated with intensive care unit (ICU) length of stay (LOS) ≥1 day: ruptured AAA, the American Society of Anesthesiology (ASA) score of 4-5, operative time ≥180 minutes, bilateral groin cut down, juxta-renal AAA, renal artery stent, aortic stent, emergency surgery, need for blood transfusion and postoperative pneumonia
ASA, American Society of Anesthesiologists; ICU LOS, intensive care unit length of stay. This analysis of a large, multi-institutional database of all Endovascular aortic aneurysm repair (EVAR) performed across the US aims to determine the factors associated with increased length of ICU stay during the postoperative period
Summary
The past two decades have seen a revolution in the surgical treatment of abdominal aortic aneurysms (AAA). Since EVAR was first described by Parodi et al, subsequent randomized controlled trials have supported its safety and efficacy [1,2,3]. EVAR has become the most common modality for the treatment of abdominal aortic aneurysms. One of the main advantages of EVAR over traditional open AAA repair is the reduced intensive care unit (ICU) and hospital length of stay (LOS). There is recent evidence to suggest that EVAR can be performed safely even in the outpatient settings [4]. In the era of increasing focus on reducing the postoperative complications, the length of stay in the intensive care unit and hospital, and healthcare costs, hospitals are developing strategies to improve these metrics
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