title: Trends in Endovascular Aortic Aneurysm Repair Length of Stay over a Decade at a Tertiary Academic Institution.
abstract: BACKGROUND
  Length of stay (LOS) is used as a quality metric to reduce cost and improve value of delivery of care. We sought to analyze trends in endovascular aortic aneurysm repair (EVAR) LOS at a tertiary academic institution over the last decade.
  
  
  METHODS
  A retrospective review of prospectively collected data was performed. Infrarenal EVARs from 2001 to 2013 were divided into 3 groups: group I (2001-2004), EVARs were performed as part of clinical trials; group II (2005-2008), EVARs were referred to a tertiary referral center with the most experience with EVAR; group III (2009-2013), EVARs were referred to academic institutions in the presence of severe patient comorbidities. Trends in LOS and correlation with severity of illness (SOI) as based on All Patient Refined Diagnosis Related Groups and admission and/or disposition status were analyzed. LOS index (LOSI) at our institution was then compared with University HealthSystem Consortium (UHC) Hospitals over the past 3 years.
  
  
  RESULTS
  A total of 1,265 EVARs were performed during this time period: 325 in group I, 547 in group II, and 393 in group III. The median LOS was 4 days (inter quartile range [IQR], 2-6) vs. 3 days (IQR, 2-5) ± 0.28 vs. 4 days (IQR, 3-7), respectively (P < 0.01). Although moderate SOI was fairly constant over time (P = 0.66), major and/or extreme SOI constituted a greater proportion of patients in group I, was reduced in group II, and was again increased in group III, P < 0.01. The complication rate paralleled this pattern (group I, 15.2%; group II, 8.6%; group III, 10.4%; P = 0.02). The percentage of patients discharged to nursing home and/or rehab was 5.7% in group I, 8.2% in group II, 11.5% in group III (P = 0.03). Cases that were performed urgently and/or emergently increased over time: 11.6% in group I, 14.9% in group II, 21.6% in group III (P = 0.01). The risk-adjusted LOSI at our institution was significantly greater (1.25) when compared with UHC hospitals (0.75).
  
  
  CONCLUSIONS
  Our study suggests a relationship between time period of EVAR, SOI, complications, admission status, and LOS. Attention to these trends could be used to decrease LOS in an increasingly complex patient population.
authors.affiliation: Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Yana
authors.initials: Y
authors.lastname: Etkin
authors.affiliation: Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.affiliation: Department of Vascular Surgery, MedStar Health, Washington, DC.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.affiliation: Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foley
authors.affiliation: Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Rohrbach
authors.affiliation: Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.affiliation: Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: Grace.Wang@uphs.upenn.edu.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome