Prateek K. Gupta1, Travis L. Engelbert1, Bala Ramanan2, Xiang Fang2, Dai Yamanouchi1, John R. Hoch1, Charles W. Acher1
1Surgery, University of Wisconsin Hospital and Clinics, Madison, WI; 2Creighton University, Omaha, NE.
OBJECTIVES: Outcome improvement in the field of aortic surgery, specifically endovascular repair (EVAR) of abdominal aortic aneurysms (AAA), has received much attention. The focus, however, has been on inpatient outcomes. With EVAR, the index hospital stay after aortic surgery has decreased significantly, leaving a need for better understanding of post-discharge outcomes, which is necessary to improve quality and reduce readmission rates with proper targeted outpatient interventions. The objective of this study was to examine post-discharge 30-day outcomes after elective EVAR.
METHODS: Patients who underwent an elective EVAR for AAA (n=11,229) were identified from the ACS' 2005-10 NSQIP database. Univariable and multivariable logistic regression analyses were performed.
RESULTS: The median age for the patient cohort was 75 years with 82.7% males. The median (interquartile range (IQR)) length of hospital stay was 2 (1-3) days. Overall 30-day mortality rate was 1% (n=117), with 31% (n=36) of the patients dying after discharge. Overall 30-day morbidity rate was 10.7% (n=1204), with 37.9% (n=456) of the morbidities being post-discharge. The median time of death and complication was 9 and 3 days, respectively, after surgery. Eighty-one percent of the wound infections (n=190/234), 28% of pneumonia (n=37/133), and 51% of DVT (n=27/53) were post-discharge. On multivariable analyses, age, dependent functional status, postoperative pneumonia and postoperative renal failure were independently associated with post-discharge mortality, and female gender and diabetes with post-discharge morbidity (p<0.05 for all).
CONCLUSIONS: A third of deaths and complications after EVAR are post-discharge. Improved pre-discharge surveillance and close post-discharge follow-up of identified high-risk patients may further improve 30-day outcomes after EVAR. Post-discharge interventions are needed and should focus on complications with high rates of occurrence after the index hospitalization.
AUTHOR DISCLOSURES: C. W. Acher: Nothing to disclose; T. L. Engelbert: Nothing to disclose; X. Fang: Nothing to disclose; P. K. Gupta: Nothing to disclose; J. R. Hoch: Nothing to disclose; B. Ramanan: Nothing to disclose; D. Yamanouchi: Nothing to disclose.
Posted April 2013