Safety and feasibility of endovascular aortic aneurysm repair as day surgery

Stephen C. Hanley, Oren Steinmetz, Eva S. Mathieu, Daniel Obrand, Kent Mackenzie, Marc Michel Corriveau, Cherrie Abraham, Heather L. Gill

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: The adoption of endovascular aneurysm repair (EVAR) during the past two decades has led to significantly shorter length of stay as well as lower hospital resource use. Currently, most patients are admitted to the hospital after EVAR; however, there are no standard observation periods, and timing of discharge is based on clinical judgment. The aim of this study was to confirm the safety and feasibility of performing EVAR as outpatient surgery. Methods: We developed criteria to identify patients for potential same-day discharge (infrarenal aneurysm, low perioperative risk, to be accompanied for first 24 hours). We then implemented a prospective trial that observed patients planned for same-day discharge and compared them with a historical control group (patients who had undergone EVAR during the previous 2 years and met same-day discharge criteria). Basic demographic and operative data as well as length of stay, inpatient and perioperative complications, emergency department visits, readmissions, reinterventions, and deaths were collected. The primary outcome was the 30-day complication rate, and the study was powered to assess noninferiority. Results: Prospectively, we assessed 266 patients and planned 110 (41%) for outpatient EVAR (62% of historical controls met outpatient criteria). Demographic characteristics were similar between planned outpatients and historical controls. In planned outpatients, hospital stay was significantly shorter (0.7 ± 2.6 days vs 2.5 ± 6.9 days; P < .01), and 79% were discharged the same day of surgery. The 30-day follow-up was available for all study patients and 94% of control patients; there were no differences in complication (11% vs 9%), readmission (2% vs 4%), reintervention (4% vs 4%), or mortality (1% vs 1%) rates, but study patients had significantly more emergency department visits (15% vs 6%; P < .05). Unsuccessful same-day discharge was associated with longer operative times, increased blood loss, and use of general anesthesia. Conclusions: In selected patients undergoing elective EVAR, same-day discharge is feasible without increasing complication rates. Health resource utilization remains a challenge in transitioning to an outpatient model.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Aortic Aneurysm
Ambulatory Surgical Procedures
Aneurysm
Safety
Outpatients
Length of Stay
Hospital Emergency Service
Demography
Health Resources
Operative Time
General Anesthesia
Inpatients
Observation
Control Groups
Mortality

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Hanley, S. C., Steinmetz, O., Mathieu, E. S., Obrand, D., Mackenzie, K., Corriveau, M. M., ... Gill, H. L. (Accepted/In press). Safety and feasibility of endovascular aortic aneurysm repair as day surgery. Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2017.10.073

Safety and feasibility of endovascular aortic aneurysm repair as day surgery. / Hanley, Stephen C.; Steinmetz, Oren; Mathieu, Eva S.; Obrand, Daniel; Mackenzie, Kent; Corriveau, Marc Michel; Abraham, Cherrie; Gill, Heather L.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Hanley, Stephen C. ; Steinmetz, Oren ; Mathieu, Eva S. ; Obrand, Daniel ; Mackenzie, Kent ; Corriveau, Marc Michel ; Abraham, Cherrie ; Gill, Heather L. / Safety and feasibility of endovascular aortic aneurysm repair as day surgery. In: Journal of Vascular Surgery. 2018.
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AU - Corriveau, Marc Michel

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AU - Gill, Heather L.

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