Preliminary Results of a Prospective Trial of Endovascular Aortic Aneurysm Repair as Day Surgery

Abstract

Endovascular aortic aneurysm repair (EVAR) allows reduced perioperative morbidity, mortality, and length of stay while maintaining long-term results equivalent to those of open repair. Currently, most patients are admitted to the hospital after EVAR; however, there are no standard observation periods, and timing of discharge is based on clinical judgment. The aim of this study was to validate criteria for targeting patients for outpatient EVAR and to assess the safety of outpatient EVAR. We developed criteria to target patients for potential outpatient EVAR (infrarenal aneurysm, low perioperative risk, to be accompanied for first 24 hours). We then prospectively selected patients for planned outpatient EVAR and compared them with a historical control group (patients who had undergone EVAR during the previous 3 years and met outpatient criteria). We collected demographic and operative data, length of stay, complications, emergency department visits, readmissions, reinterventions, and deaths. The primary outcome was the 30-day complication rate, and this study was designed to assess noninferiority. Prospectively, we have assessed 159 patients and planned 60 (38%) for outpatient EVAR (57% of historical controls met outpatient criteria). Compared with controls, planned outpatients are younger (75 ± 1 vs 79 ± 1 years; P < .01) but have otherwise similar demographics. In planned outpatients, hospital stay is significantly shorter (0.7 ± 0.4 vs 2.8 ± 0.9 days; P < .05), and 47 (78%) were discharged the same day. The 30-day follow-up was available for 88% of both groups; there were no differences in complication (15% vs 15%), emergency department visit (21% vs 12%), readmission (4% vs 7%), reintervention (6% vs 8%), or mortality (2% vs 1%) rates. In well-selected patients, preliminary results suggest that outpatient EVAR is feasible without increasing complication rates or health care resource utilization. However, these data represent early results of an ongoing study designed to establish noninferiority of outpatient EVAR.