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Advanced Age, Dependency Predict Nonhome Discharge After Endovascular Repair of Abdominal Aortic Aneurysm

Key findings

  • 4.6% of 6,276 previously home-dwelling patients required nonhome discharge following endovascular repair of an abdominal aortic aneurysm
  • Patients 80 and older and those dependent on others before surgery were most likely to require nonhome discharge
  • Other predictors of nonhome discharge were an open wound preoperatively and female sex

Patient counseling before surgical repair of an abdominal aortic aneurysm (AAA) usually focuses on the potential for major morbidity and mortality. Yet, previous research suggests that patients are also concerned about how long their recovery will last.

Endovascular aneurysm repair (EVAR) of AAA is known to be associated with a shorter hospital stay and enhanced recovery, compared with open repair. However, no study has examined who is at risk of functional decline after endovascular repair and less likely to be discharged directly to home.

In a retrospective study published in the Annals of Vascular Surgery, Laura T. Boitano, MD, vascular surgery resident, Mark F. Conrad, MD, director of clinical research, Division of Vascular and Endovascular Surgery, and colleagues determined that age and preoperative functional status were the most important factors predicting whether a patient undergoing EVAR would be able to go home directly from the hospital.

The researchers evaluated 6,276 patients in the American College of Surgeons National Surgical Quality Improvement Program and the Vascular Targeted Participant Use Data Files who underwent elective infrarenal aortic repair using EVAR between 2011 and 2015. 4.6% of them required nonhome discharge to a rehabilitation unit, separate acute care facility, skilled care facility or unskilled care facility.

Strongest Predictors of Nonhome Discharge

Multivariable binary logistic regression analysis demonstrated that the strongest predictors of nonhome discharge were:

  • Age 90+ (odds ratio 14.6)
  • Age 80–89 (odds ratio 5.7)
  • Partial or total dependence in activities of daily living preoperatively (odds ratio 5.4)

Nine percent of octogenarians and 19.6% of nonagenarians required nonhome discharge, compared with 1.5% of patients younger than 60.

Frailty is suggested by some experts to be more important than chronological age in determining surgical outcomes. Besides functional status, most frailty indexes consider preoperative nutritional status, weight loss and comorbid conditions. After risk adjustment, none of those factors was an independent predictor of nonhome discharge in this study.

Other Predictors of Nonhome Discharge

Other independent preoperative predictors of nonhome discharge were an open wound (odds ratio 3.5) and female sex (odds ratio 2.2). The researchers note that women have smaller vessel diameters than men do, which can be more difficult to repair, and that women undergoing EVAR are more likely than men to have untreated comorbid conditions.

The research team also notes that women are often in the caregiver role and might have a family that is unable to care for them, or they may have outlived their spouse or partner. Supporting the latter idea, women in this study were on average three years older than men (76 vs. 73, < .001). However, the databases consulted did not contain information on social support and how it might have affected discharge status.

The authors caution that the predictors they identified need to be validated in prospective studies before they are applied clinically. They believe it would be worthwhile to develop a scoring system that would predict the risk of nonhome discharge, for use in counseling patients preoperatively.

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