Factors Affecting Longer Stay and Higher Costs during Elective Open Repair for Abdominal Aortic Aneurysm: A Case-Control Study

Abstract

Open surgery for abdominal aortic aneurysm (AAA) has the advantage of requiring less reintervention compared with endovascular aneurysm repair. The reduction of the initial hospitalization costs can provide socioeconomic benefits. The objective of this study was to determine the factors associated with an increase in the length of hospital stay and costs of open surgery for AAA. A total of 579 consecutive patients who underwent open surgery for intact AAA and survived, between 1998 and 2015 at Asahi General Hospital in Japan, were included in the analysis. Patients' characteristics, aneurysm morphology, operative procedures, postoperative complications, and postoperative courses were analyzed in relation to the hospital length of stay and costs. Patients with longer stays or higher costs (exceeding the third quartile) were compared with those with stays or costs no more than the third quartile. The mean patient age was 75±8years, and 492 patients (85%) were male, with a mean aortic diameter of 57±10mm. The mean operation time was 214±56min with an estimated mean blood loss of 444±305g. Transfusion was required in 28 patients (4.8%) and return to the operating room (RTOR) in 18 patients (3.1%). The median postoperative hospital stay was 7 (7-8) days. Median costs of hospitalization were 12,300 (11,800-13,100) United States Dollar. In the multivariate analysis, the major factors which increased the length of stay were transfusion, late ambulation, and prolonged fasting time. Major risk factors for higher total hospitalization costs were transfusion, RTOR, and longer fasting time. Regardless of the patients' comorbidities or aneurysm morphology, avoidance of transfusion and RTOR, combined with early ambulation and enteral feeding in the postoperative care, can reduce the length of stay and total hospitalization costs associated with open surgery for AAA.