title: Preoperative Risk Factors Predict Protracted Hospital Length of Stay after Elective Endovascular Abdominal Aortic Aneurysm Repair.
abstract: BACKGROUND
  One of the main advantages of endovascular abdominal aortic aneurysm repair (EVAR) is shorter postoperative hospital length of stay (LOS) compared to open repair. However, patients with preexisting conditions may be predisposed to a protracted LOS. Our aim was to identify preoperative risk factors for prolonged postoperative LOS after elective EVAR.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database (2005-2013) was used to analyze all patients undergoing elective EVAR without adjunctive procedures. The upper quartile (≥3 days) was used to define protracted LOS. Preoperative risk factors with significant association (P < 0.2) were used to develop a logistic regression model for protracted postoperative LOS.
  
  
  RESULTS
  There were 21,769 patients that underwent elective EVAR with a median LOS of 2 days. The strongest independent preoperative predictors of LOS were chronic renal insufficiency (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.7-5.2), admission from a facility (OR: 2.7, 95% CI: 2.2-3.2), dependent functional status (OR: 2.6, 95% CI: 2.2-3.1), recent weight loss (OR: 2.2, 95% CI: 1.7-2.9), the American Society of Anesthesiologists class IV (OR: 1.9, 95% CI: 1.6-2.3), congestive heart failure (OR: 1.8, 95% CI: 1.4-2.4), female gender (OR: 1.7, 95% CI: 1.6-1.9), non-Caucasian race (OR: 1.7, 95% CI: 1.5-1.9), and dyspnea at rest (OR: 1.5, 95% CI: 1.2-2.0). Patients with a protracted postoperative LOS were more likely to require discharge to a facility (21.8% vs. 2.1%, P < 0.001) and were more likely to be readmitted within 30 days (5.3% vs. 3.3%, P < 0.001).
  
  
  CONCLUSIONS
  Preoperative demographics and comorbidities represent significant risk factors for prolonged LOS after elective EVAR. These findings provide an important evidence basis for ongoing efforts to reduce health care spending by prospectively identifying high-risk patients. Preoperative targeting of these patients through multidisciplinary efforts may reduce costs and improve outcomes.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: King
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA. Electronic address: Jeffrey.Siracuse@bmc.org.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D044469:Racial Groups; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States