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J Surg Res. 2019 Mar;235:543-550. doi: 10.1016/j.jss.2018.10.039. Epub 2018 Nov 26.

Predicting Postoperative Destination Through Preoperative Evaluation in Elective Open Aortic Aneurysm Repair.

Author information

1
Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: lboitano@partners.org.
2
Division of Vascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, California.
3
Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

There are limited data guiding preoperative counseling on the need for discharge to facility after elective open abdominal aortic aneurysm repair (OAR). This study aims to determine the preoperative predictors for nonhome discharge (NHD) following OAR.

MATERIALS AND METHODS:

The National Surgical Quality Improvement Program Vascular Procedure Targeted database was queried for elective OAR, 2011-2015. The primary endpoint was NHD. Complex surgery was defined as high operative time. Multivariable logistic regression identified preoperative factors predictive of NHD.

RESULTS:

Overall 510 patients were included; 87 (17.1%) required NHD. Baseline characteristics differed: NHD were more frequently female, partially dependent, older, had history of chronic obstructive pulmonary disease, bleeding disorder, and anemia. After risk adjustment, age≥70 y (odds ratio [OR]: 12.48, confidence interval [CI]: 2.89-53.99; P = 0.001), partial dependence (OR: 8.17, CI: 1.39-47.84; P = 0.02), female sex (OR: 1.88, CI: 1.10-3.20; P = 0.02), history of bleeding disorder (OR: 2.65, CI: 1.14-6.15; P = 0.02), and high operative time (OR: 1.84, CI: 1.03-3.26; P = 0.04) were independent predictors of NHD. On unadjusted analysis, NHD was not associated with increased major postdischarge complications (OR: 1.52, CI: 0.48-4.78; P = 0.47 P = 0.47) or unplanned readmission (OR: 0.74, CI: 0.25-2.16; P = 0.58) CONCLUSIONS: NHD following OAR can be predicted using preoperative factors including age, functional status, sex, history of bleeding disorder, and complex repair. NHD was not associated with more major postdischarge complications or unplanned readmission. A better understanding of patients at risk for NHD will allow for better preoperative counseling and will help to set appropriate expectations.

KEYWORDS:

Abdominal aortic aneurysm; Functional outcomes; Open abdominal aortic aneurysm repair; Outpatient rehabilitation

PMID:
30691841
DOI:
10.1016/j.jss.2018.10.039

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