Editor's Choice – Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome

Abstract

The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era. All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as ≥ 48h during the primary hospital stay. Patients surviving ≥ 48h after AAA surgery were included in the analysis. A total of 725 patients were identified, of whom 707 (97.5%) survived≥48h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required<48h of intensive care, 115 (16.3%) 2-6 days and 44 (6.2%)≥7 days. The rate of prolonged ICU LOS declined considerably over time, from 41.4% of all AAA repairs in 1999 to 7.3% in 2013 (p<.001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p<.001). The 30 day survival rate was 98.2% for those with < 48h ICU stay versus 93.0% for 2-6 days versus 81.8% for ≥ 7 days (p<.001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p<.001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups. During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected.