title: Postdischarge outcomes after endovascular abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. The objective of this study was to examine postdischarge 30-day outcomes after elective EVAR.
  
  
  METHODS
  Patients who underwent an elective EVAR for AAA (n = 11,229) were identified from the American College of Surgeons 2005-2010 National Surgical Quality Improvement Project database. Univariable and multivariable logistic regression analyses were performed.
  
  
  RESULTS
  The median length of hospital stay was 2 days (interquartile range, 1-3 days). Overall 30-day mortality was 1.0% (n = 117), with 31% (n = 36) of the patients dying after discharge. Overall 30-day morbidity was 10.7% (n = 1204), with 40% (n = 500) of the morbidities being postdischarge. The median time of death and complication was 9 and 3 days, respectively, after surgery. Eighty-eight percent of the wound infections (n = 205 of 234), 33% of pneumonia (n = 44 of 133), and 55% of venous thromboembolism (n = 36 of 65) were postdischarge. Multivariable analyses showed age, congestive heart failure, admission from nursing facility, postoperative pneumonia, myocardial infarction, and renal failure were independently associated with postdischarge mortality, and peripheral arterial disease, female gender, previous cardiac surgery, age, smoking, and diabetes with postdischarge morbidity (P < .05 for all).
  
  
  CONCLUSIONS
  Patient characteristics associated with a higher risk for postdischarge adverse events after EVAR were identified. Whether improved predischarge surveillance and close postdischarge follow-up of identified high-risk patients will further improve 30-day outcomes after EVAR needs to be prospectively studied.
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc. Electronic address: pgupta@uwhealth.org.
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
authors.forename: Travis L
authors.initials: TL
authors.lastname: Engelbert
authors.affiliation: Department of Surgery, Creighton University, Omaha, Neb.
authors.forename: Bala
authors.initials: B
authors.lastname: Ramanan
authors.affiliation: Department of Biostatistics, Creighton University, Omaha, Neb.
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
authors.forename: Dai
authors.initials: D
authors.lastname: Yamanouchi
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
authors.forename: John R
authors.initials: JR
authors.lastname: Hoch
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Acher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States