Preoperative Risk Factors Predict Protracted Hospital Length of Stay after Elective Endovascular Abdominal Aortic Aneurysm Repair

Abstract

One of the main advantages of endovascular abdominal aortic aneurysm repair (EVAR) is shorter postoperative hospital length of stay (LOS) compared to open repair. However, patients with preexisting conditions may be predisposed to a protracted LOS. Our aim was to identify preoperative risk factors for prolonged postoperative LOS after elective EVAR. The American College of Surgeons National Surgical Quality Improvement Program database (2005-2013) was used to analyze all patients undergoing elective EVAR without adjunctive procedures. The upper quartile (≥3days) was used to define protracted LOS. Preoperative risk factors with significant association (P<0.2) were used to develop a logistic regression model for protracted postoperative LOS. There were 21,769 patients that underwent elective EVAR with a median LOS of 2days. The strongest independent preoperative predictors of LOS were chronic renal insufficiency (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.7-5.2), admission from a facility (OR: 2.7, 95% CI: 2.2-3.2), dependent functional status (OR: 2.6, 95% CI: 2.2-3.1), recent weight loss (OR: 2.2, 95% CI: 1.7-2.9), the American Society of Anesthesiologists class IV (OR: 1.9, 95% CI: 1.6-2.3), congestive heart failure (OR: 1.8, 95% CI: 1.4-2.4), female gender (OR: 1.7, 95% CI: 1.6-1.9), non-Caucasian race (OR: 1.7, 95% CI: 1.5-1.9), and dyspnea at rest (OR: 1.5, 95% CI: 1.2-2.0). Patients with a protracted postoperative LOS were more likely to require discharge to a facility (21.8% vs. 2.1%, P<0.001) and were more likely to be readmitted within 30days (5.3% vs. 3.3%, P<0.001). Preoperative demographics and comorbidities represent significant risk factors for prolonged LOS after elective EVAR. These findings provide an important evidence basis for ongoing efforts to reduce health care spending by prospectively identifying high-risk patients. Preoperative targeting of these patients through multidisciplinary efforts may reduce costs and improve outcomes.