title: Potential clinical feasibility and financial impact of same-day discharge in patients undergoing endovascular aortic repair for elective infrarenal aortic aneurysm.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the potential feasibility and financial impact of same-day discharge after elective endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm.
  
  
  METHODS
  All elective EVARs performed between January 2012 and June 2013 were identified. Demographics, comorbidities, complications, nursing care, financial data, and length of stay were analyzed.
  
  
  RESULTS
  Sixty-seven (73%) EVARs were performed electively, 73% percutaneously. Intraoperative complications were blood loss requiring transfusion (4.5%), thrombosis (3%), femoral artery injury (1.5%), postoperative urinary retention (4.5%), myocardial infarction (3%), respiratory failure (1.5%), congestive heart failure (1.5%), and hemodynamic or rhythm alterations (37%; evident in 88% <6 hours; 13% required therapy). Monitoring only was needed in 28 patients (42%), intensive care in 15%. Seventy-two percent were discharged on postoperative day one; 6% were readmitted <30 days. Telemetry, oxygen, intravenous hydration, and urinary catheters (routine services) were used for shorter periods in uncomplicated patients and those discharged on postoperative day 1. Total hospital costs were $29,479: operating room, 80.3%; anesthesia, 2.2%; preadmission, 1%; postanesthesia unit, 3.1%; intensive care unit, 1.9%; floor, 4.7%; laboratory and diagnostic tests, 1.2%; pharmacy, 1.4%; other, 4.2%. Total cost was similar for those discharged <20 hours or ≥24 to 31 hours postoperatively (P = .51) and for monitoring only vs others ($28,146 vs $30,545; P = .12). Pharmacy ($351 vs $509; P = .05), laboratory work ($86 vs $355; P = .01), and diagnostic testing ($4 vs $254; P = .02) costs were lower for uncomplicated cases.
  
  
  CONCLUSIONS
  Same-day discharge is clinically feasible in >40% of elective EVARs but requires coordination for adequate postoperative monitoring. Significant savings are unlikely as most cost is operating room and device related, and further reduction of costs in uncomplicated cases is unlikely.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Moscato
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Monica S
authors.initials: MS
authors.lastname: O'Brien-Irr
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University at Buffalo, State University of New York, Buffalo, NY; Division of Vascular Surgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY.
authors.forename: Maciej L
authors.initials: ML
authors.lastname: Dryjski
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University at Buffalo, State University of New York, Buffalo, NY; Division of Vascular Surgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cherr
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University at Buffalo, State University of New York, Buffalo, NY; Division of Vascular Surgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY. Electronic address: lharris@kaleidahealth.org.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Harris
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015897:Comorbidity; D017046:Cost Savings; D017558:Elective Surgical Procedures / Q000191:economics; D057510:Endovascular Procedures / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies