Preoperative Predictors of Nonhome Discharge After Fenestrated-Branched Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms

Abstract

Nonhome discharge (NHD) to skilled nursing facilities or rehabilitation units has significant implications for patient counseling and discharge planning and is frequently required following fenestrated-branched endovascular aneurysm repair (FB-EVAR) of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA). We aimed to identify preoperative predictors of NHD after elective FB-EVAR for CAAA and TAAA. A retrospective review of prospectively collected data on all patients undergoing FB-EVAR between January 2010 and December 2020 at a single institution was performed. Patients undergoing elective repair who were residing at home at the time of index operation were included. Univariate and multivariate analysis was performed to identify factors associated with NHD. From the initial cohort of 612 patient having FB-EVAR during the study period, 575 (74% male; mean age, 74.6 ± 7.8 YEARS) patients had elective surgery, including 403 for CAAA (70%) and 172 for TAAA (30%). Early mortality occurred in seven patients (four in CAAA three 3 in TAAA) and mean total length of hospital stay was 7.1 days (5.9 for CAAA and 10.0 for TAAA). There were 482 patients (84%) who were discharged home and 93 (16%) had NHD. NHD was associated with increasing age (mean age 77 years in NHD group vs 74 years), female gender (27% of females vs 12% of males), a history of congestive heart failure (CHF; 28% vs 15%) or peripheral arterial disease (23% vs 14%), and extent I, II, and III TAAA (27%, 24%, and 25%, respectively; all P = .004). Body mass index, race, prior stroke, device type, and number of target vessels were not associated with NHD. On multivariate analysis, older age (odds ratio [OR], 1.08 per year), female gender (OR, 2.51), CHF (OR, 2.59), and extent I (OR, 3.27), II (OR, 3.77), and III (OR, 3.13) TAAAs were associated with NHD (Figure). Older female patients with CHF and more extensive aneurysms are at higher risk of NHD following FB-EVAR. Following further internal validation, these data will be used to develop a predictive calculator of NHD, therefore allowing preoperative counselling of these patients and initiation of referrals with appropriate facilities that may expedite postoperative discharge.