Factors that predict prolonged length of stay after aortic surgery.
OBJECTIVE
In this era of managed health care, third-party payers insist that surgeons minimize hospital stay even after major operations such as aortic surgery. We attempted to identify risk factors that predict prolonged hospital length of stay (LOS) so that realistic expectations can be established for these patients who frequently are at high-risk.


METHODS
In 1994 a clinical pathway for aortic surgery was implemented at our hospital. Between January 1, 1994, and December 31, 2000, data including identifiable risk factors and LOS were reviewed for 240 patients who underwent elective infrarenal aortic surgery to treat aneurysmal (n = 179) or occlusive (n = 61) disease. Risk factors were analyzed to determine their effect on LOS. Data for patients who underwent endovascular, emergency, or concomitant cardiac surgery were excluded from analysis.


RESULTS
In-hospital mortality was 0.4% (1 of 240 patients), and morbidity was 18% (44 of 240 patients). Mean LOS was 8.2 +/- 5.7 days for all patients, 6.9 +/- 2.9 days for those without complications, and 13.8 +/- 6.7 days for patients with complications (P <.0001). Factors that predicted prolonged LOS (Kaplan-Meier method) included age older than 75 years (P =.0004), chronic obstructive pulmonary disease (COPD; P =.0351), intraoperative blood loss more than 500 mL (P =.0006), duration of surgery more than 5 hours (P <.0001), wound infection (P =.0311), and postoperative complications overall (P <.0001). Remaining factors associated with prolonged LOS (Cox regression analysis) included age older than 75 years (P =.0050), COPD (P =.0445), and complications overall (P =.0094).


CONCLUSIONS
The only identifiable preoperative risk factors that correlated with increasing LOS after elective infrarenal aortic surgery (multivariate analysis) were increasing age and COPD. Third-party payers should allow longer hospitalization for patients older than 75 years and for patients with significant pulmonary disease.
Chang
Jeanette K
JK
Section of Vascular Surgery, Pennsylvania Hospital, 700 Spruce Street, Suite 101, Philadelphia, PA 19106, USA.
Calligaro
Keith D
KD
Lombardi
Joseph P
JP
Dougherty
Matthew J
MJ
D000367:Age Factors; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012307:Risk Factors; D014656:Vascular Surgical Procedures