Same-day discharge feasible in certain patients undergoing EVAR

Same-day discharge is a viable option that does not increase complication rates or health care resource utilization in select patients undergoing endovascular aortic aneurysm repair, according to a presentation from the 2017 Society for Vascular Surgery Annual Meeting.

The data presented by Stephen Hanley, MD, PhD, vascular surgery fellow at Tufts Medical Center in Brookline, Massachusetts, were collected to confirm the safety and feasibility of performing endovascular aneurysm repair as an outpatient procedure.

“The adoption of EVAR over the past 15 years has led to significantly decreased length of stay as well as hospital resource utilization,” Hanley and colleagues wrote in an abstract. “Currently, most patients are admitted to the hospital post-EVAR; however, there are no standard observation periods and timing of discharge is based on clinical judgement.”

According to the researchers, criteria were developed for the targeting of patients who could potentially be eligible for same-day discharge, including those with infrarenal aneurysm and those at low perioperative risk.

A prospective trial was then conducted to follow patients planned for same-day discharge and a historical control group of patients who had undergone EVAR over the previous 3 years and met same-day discharge criteria.

Researchers collected basic demographic and operative data. The primary outcome was 30-day complication rate. Other outcomes of interest included length of stay, inpatient and perioperative complications, ED visits, readmissions, reinterventions and mortality.

The prospective trial assessed 213 patients, 89 (42%) of whom were planned for outpatient EVAR (57% of historical controls met outpatient criteria).

Planned outpatients were younger in comparison to control patients (76 years vs. 79 years, P < .01). All other demographics between the two groups were similar.

There was a significantly shorter length of stay for planned outpatients vs. controls (0.5 ± 0.3 days vs. 2.8 ± 0.9 days), and 82% of planned outpatients were discharged the same day.

Thirty-day data were available for 99% of patients included in the study and 88% of patients in the control group. At 30 days, there was no difference in rates of complications (study group, 10%; controls, 15%), ED visit (study group, 18%; controls, 12%), readmission (study group, 2%; controls, 7%), reinterventions (study group, 5%; control group, 8%) or mortality rates (both groups, 1%).

The success of same-day discharge was linked to percutaneous access, shorter operative times, less blood loss and use of locoregional anesthesia, Hanley and colleagues reported. – by Dave Quaile

Reference:

Hanley S, et al. S1: William J. von Liebig Forum. Presented at: Society for Vascular Surgery Vascular Annual Meeting; May 31-June 3, 2017; San Diego.

Disclosure: Hanley reports no relevant financial disclosures.