Preoperative Predictors of Discharge Destination Following Endovascular Repair of Abdominal Aortic Aneurysms.

OBJECTIVES: There is a paucity of data guiding preoperative counselling on the need for discharge to a facility or non-home discharge (NHD) following elective endovascular repair of abdominal aortic aneurysms (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 post-discharge 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 endpoint was NHD. A multivariable logistic regression model was used to determine predictive preoperative factors for NHD and to determine whether NHD predicted major post-discharge complications and readmission.

RESULTS: Overall 6,276 cases were included; 291(4.6%) required NHD. NHD were more frequently female, anemic, functionally dependent, non-smokers, had COPD, recent CHF exacerbation, and open baseline wounds. NHD was associated with complex surgery, indicated by operative time more than the median, 2.5 hours. Significant predictors for NHD on multivariable analysis included female sex (OR: 2.2, 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 post-discharge 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).

CONCLUSION: 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, facilitate early referral to skilled facilities that may reduce hospital length of stay reducing healthcare costs.