Preoperative Predictors of Discharge Destination after Endovascular Repair of Abdominal Aortic Aneurysms

Abstract

Background: There is a paucity of data guiding preoperative counseling on the need for discharge to a facility or nonhome discharge (NHD) following elective endovascular repair of abdominal aortic aneurysms (endovascular aneurysm repair [EVAR]). This study seeks to determine the preoperative predictors of NHD following EVAR in baseline home-dwelling patients and to determine whether NHD is associated with major postdischarge complications and readmission.

Methods: This retrospective cohort study utilized the National Surgical Quality Improvement Program Vascular Procedure Targeted database to identify elective EVAR cases admitted from home (2011 to 2015). The primary end point was NHD. A multivariable logistic regression model was used to determine predictive preoperative factors for NHD and to determine whether NHD predicted major postdischarge complications and readmission.

Results: Overall 6,276 cases were included; 291 (4.6%) required NHD. NHD were more frequently female, anemic, functionally dependent, nonsmokers, had chronic obstructive pulmonary disease, recent congestive heart failure exacerbation, and open baseline wounds. NHD was associated with complex surgery, indicated by operative time more than the median, 2.5 hr. Significant predictors for NHD on multivariable analysis included female sex (odds ratio [OR]: 2.2, confidence interval [CI]: 1.7-2.9, P < 0.001), octogenarians (OR: 5.7 CI: 2.3-14.1; P < 0.001) and nonagenarians (OR: 14.6, CI: 5.4-39.2; P < 0.001), dependent functional status (OR: 5.4, CI: 3.3-8.8; P < 0.001), preoperative open wound (OR: 3.5, CI: 1.4-8.9; P = 0.006), high operative time (OR: 2.7, CI: 2.0-3.6; P < 0.001), and hypogastric embolization (OR: 1.6, CI: 1.1-2.1 P = 0.022), C-statistic = 0.780. On adjusted analysis, NHD did not independently predict major postdischarge complication (OR: 1.0 CI: 0.6-1.9; P = 0.875) or unplanned readmission (OR 1.0, CI: 0.6-1.5, P = 0.842).

Conclusions: Discharge to skilled facility following EVAR can be predicted using preoperative factors. Future studies should seek to validate these findings in a prospective manner. Identifying high-risk patients' NHD can help define expectations and facilitate early referral to skilled facilities that may reduce hospital length of stay, reducing health-care costs.