Abstract
ObjectivesThe average hospital length of stay plays a significant role in healthcare costs, and is also used as a metric of hospital efficiency. An advantage of endovascular abdominal aortic aneurysm repair (EVAR) is the shorter postoperative time period after the surgery. The purpose of this study is to review the factors associated with increased length of stay after EVAR.MethodsThe records from American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database in 2013 were obtained using Procedure Participant User File. Pre-, intra-, and post-operative factors were assessed of patients undergoing EVAR in 2013. Multivariable logistic regression analysis was used to identify independent variables for a hospital length of stay of at least seven days.ResultsA total of 1,991 patients (18.7% female, 81.3% males) underwent EVAR in 2013. Among these patients, 223 (11.2%) had a hospital stay greater than seven days. Variables significantly associated with length of stay in a multivariable model included: total operation time greater than 180 minutes (vs. less than 90 minutes, OR 1.88, CI 1.03-3.41, p = 0.039), postoperative, and intraoperative transfusions (OR 2.60, CI 1.66-4.08, p < 0.001), return to operating room (OR 2.88, CI 1.55-5.38, p < 0.001), rupture indication for surgery (OR 5.59, CI 3.18-9.83, p < 0.001), myocardial infarction (OR 5.85, CI 2.22-15.43, p < 0.001), preoperative transfusion (OR 13.05, CI 4.26-39.99, p < 0.001), and on ventilator greater than 48 hours (OR 49.65, CI 10.72-230.07, p < 0.001).ConclusionsMultiple factors affect length of hospital stay in patients who have undergone EVAR. Patients with postoperative respiratory failure after EVAR have a significantly higher risk for longer hospital stays.
Highlights
In the United States health care system, there has been an emphasis on providing the best patient care while simultaneously maximizing hospital efficiency and expenditures
The purpose of this study is to review the factors associated with increased length of stay after endovascular abdominal aortic aneurysm repair (EVAR)
EVAR is quickly becoming the preferred treatment for patients with Abdominal aortic aneurysms (AAA), due to its shorter postoperative length of stay (LOS) compared to open repair
Summary
In the United States health care system, there has been an emphasis on providing the best patient care while simultaneously maximizing hospital efficiency and expenditures. One factor that is commonly analyzed is length of stay (LOS), which is used as a proxy for resource utilization and healthcare delivery cost [1-3]. By understanding factors that play a role in LOS, hospital administration and leaders may be able to improve unnecessarily long hospital stays without negatively impacting patient outcomes. Abdominal aortic aneurysms (AAA) with large diameter aneurysms are known to have an increased risk of rupture, and in turn, mortality. This disease process can be treated with either open AAA repair or endovascular abdominal aortic aneurysm repair (EVAR). EVAR is quickly becoming the preferred treatment for patients with AAA, due to its shorter postoperative LOS compared to open repair
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