Postdischarge outcomes after endovascular abdominal aortic aneurysm repair

Objective Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. The objective of this study was to examine postdischarge 30-day outcomes after elective...

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Veröffentlicht in:Journal of vascular surgery 2014-04, Vol.59 (4), p.903-908
Hauptverfasser: Gupta, Prateek K., MD, Engelbert, Travis L., MD, Ramanan, Bala, MBBS, Fang, Xiang, PhD, Yamanouchi, Dai, MD, Hoch, John R., MD, Acher, Charles W., MD
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container_end_page 908
container_issue 4
container_start_page 903
container_title Journal of vascular surgery
container_volume 59
creator Gupta, Prateek K., MD
Engelbert, Travis L., MD
Ramanan, Bala, MBBS
Fang, Xiang, PhD
Yamanouchi, Dai, MD
Hoch, John R., MD
Acher, Charles W., MD
description Objective Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. The objective of this study was to examine postdischarge 30-day outcomes after elective EVAR. Methods Patients who underwent an elective EVAR for AAA (n = 11,229) were identified from the American College of Surgeons 2005-2010 National Surgical Quality Improvement Project database. Univariable and multivariable logistic regression analyses were performed. Results The median length of hospital stay was 2 days (interquartile range, 1-3 days). Overall 30-day mortality was 1.0% (n = 117), with 31% (n = 36) of the patients dying after discharge. Overall 30-day morbidity was 10.7% (n = 1204), with 40% (n = 500) of the morbidities being postdischarge. The median time of death and complication was 9 and 3 days, respectively, after surgery. Eighty-eight percent of the wound infections (n = 205 of 234), 33% of pneumonia (n = 44 of 133), and 55% of venous thromboembolism (n = 36 of 65) were postdischarge. Multivariable analyses showed age, congestive heart failure, admission from nursing facility, postoperative pneumonia, myocardial infarction, and renal failure were independently associated with postdischarge mortality, and peripheral arterial disease, female gender, previous cardiac surgery, age, smoking, and diabetes with postdischarge morbidity ( P  < .05 for all). Conclusions Patient characteristics associated with a higher risk for postdischarge adverse events after EVAR were identified. Whether improved predischarge surveillance and close postdischarge follow-up of identified high-risk patients will further improve 30-day outcomes after EVAR needs to be prospectively studied.
doi_str_mv 10.1016/j.jvs.2013.10.057
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The objective of this study was to examine postdischarge 30-day outcomes after elective EVAR. Methods Patients who underwent an elective EVAR for AAA (n = 11,229) were identified from the American College of Surgeons 2005-2010 National Surgical Quality Improvement Project database. Univariable and multivariable logistic regression analyses were performed. Results The median length of hospital stay was 2 days (interquartile range, 1-3 days). Overall 30-day mortality was 1.0% (n = 117), with 31% (n = 36) of the patients dying after discharge. Overall 30-day morbidity was 10.7% (n = 1204), with 40% (n = 500) of the morbidities being postdischarge. The median time of death and complication was 9 and 3 days, respectively, after surgery. Eighty-eight percent of the wound infections (n = 205 of 234), 33% of pneumonia (n = 44 of 133), and 55% of venous thromboembolism (n = 36 of 65) were postdischarge. Multivariable analyses showed age, congestive heart failure, admission from nursing facility, postoperative pneumonia, myocardial infarction, and renal failure were independently associated with postdischarge mortality, and peripheral arterial disease, female gender, previous cardiac surgery, age, smoking, and diabetes with postdischarge morbidity ( P  &lt; .05 for all). Conclusions Patient characteristics associated with a higher risk for postdischarge adverse events after EVAR were identified. Whether improved predischarge surveillance and close postdischarge follow-up of identified high-risk patients will further improve 30-day outcomes after EVAR needs to be prospectively studied.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2013.10.057</identifier><identifier>PMID: 24360236</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - mortality ; Aortic Aneurysm, Abdominal - surgery ; Chi-Square Distribution ; Databases, Factual ; Elective Surgical Procedures ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Female ; Humans ; Length of Stay ; Logistic Models ; Male ; Multivariate Analysis ; Odds Ratio ; Patient Discharge ; Postoperative Complications - mortality ; Postoperative Complications - therapy ; Registries ; Risk Factors ; Surgery ; Time Factors ; Treatment Outcome ; United States</subject><ispartof>Journal of vascular surgery, 2014-04, Vol.59 (4), p.903-908</ispartof><rights>Society for Vascular Surgery</rights><rights>2014 Society for Vascular Surgery</rights><rights>Copyright © 2014 Society for Vascular Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-359b71090ff904bfa78681bec5d89bef8629e57e7a3c2575e57fcb2de826c1533</citedby><cites>FETCH-LOGICAL-c451t-359b71090ff904bfa78681bec5d89bef8629e57e7a3c2575e57fcb2de826c1533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2013.10.057$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24360236$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Prateek K., MD</creatorcontrib><creatorcontrib>Engelbert, Travis L., MD</creatorcontrib><creatorcontrib>Ramanan, Bala, MBBS</creatorcontrib><creatorcontrib>Fang, Xiang, PhD</creatorcontrib><creatorcontrib>Yamanouchi, Dai, MD</creatorcontrib><creatorcontrib>Hoch, John R., MD</creatorcontrib><creatorcontrib>Acher, Charles W., MD</creatorcontrib><title>Postdischarge outcomes after endovascular abdominal aortic aneurysm repair</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objective Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. 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Multivariable analyses showed age, congestive heart failure, admission from nursing facility, postoperative pneumonia, myocardial infarction, and renal failure were independently associated with postdischarge mortality, and peripheral arterial disease, female gender, previous cardiac surgery, age, smoking, and diabetes with postdischarge morbidity ( P  &lt; .05 for all). Conclusions Patient characteristics associated with a higher risk for postdischarge adverse events after EVAR were identified. Whether improved predischarge surveillance and close postdischarge follow-up of identified high-risk patients will further improve 30-day outcomes after EVAR needs to be prospectively studied.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - mortality</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Chi-Square Distribution</subject><subject>Databases, Factual</subject><subject>Elective Surgical Procedures</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Patient Discharge</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - therapy</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAQxUVpSDZpPkAvxcdevJmRLcumUChLmz8EEkhzFrI8TuTa1layF_bbR2bTHnLIaaThveHNbxj7jLBGwOKiW3e7sOaAWfyvQcgPbIVQybQoofrIViBzTAXH_ISdhtABIIpSHrMTnmcF8KxYsZt7F6bGBvOs_RMlbp6MGygkup3IJzQ2bqeDmXvtE103brCj7hPt_GRNokea_T4Miaettv4TO2p1H-j8tZ6xx18_f2-u0tu7y-vNj9vU5AKnNBNVLWNKaNsK8rrVsixKrMmIpqxqasuCVyQkSZ0ZLqSI79bUvKGSFwZFlp2xr4e5W-_-zhQmNcT81Pcxj5uDQoGQA68kRikepMa7EDy1auvtoP1eIagFoepURKgWhEsrIoyeL6_j53qg5r_jH7Mo-HYQUFxyZ8mrYCyNhhrryUyqcfbd8d_fuE1vR2t0_4f2FDo3-4g4bqECV6AelhsuJ8QMsOKxvACzrpcm</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Gupta, Prateek K., MD</creator><creator>Engelbert, Travis L., MD</creator><creator>Ramanan, Bala, MBBS</creator><creator>Fang, Xiang, PhD</creator><creator>Yamanouchi, Dai, MD</creator><creator>Hoch, John R., MD</creator><creator>Acher, Charles W., MD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140401</creationdate><title>Postdischarge outcomes after endovascular abdominal aortic aneurysm repair</title><author>Gupta, Prateek K., MD ; Engelbert, Travis L., MD ; Ramanan, Bala, MBBS ; Fang, Xiang, PhD ; Yamanouchi, Dai, MD ; Hoch, John R., MD ; Acher, Charles W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-359b71090ff904bfa78681bec5d89bef8629e57e7a3c2575e57fcb2de826c1533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - mortality</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Chi-Square Distribution</topic><topic>Databases, Factual</topic><topic>Elective Surgical Procedures</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Patient Discharge</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - therapy</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gupta, Prateek K., MD</creatorcontrib><creatorcontrib>Engelbert, Travis L., MD</creatorcontrib><creatorcontrib>Ramanan, Bala, MBBS</creatorcontrib><creatorcontrib>Fang, Xiang, PhD</creatorcontrib><creatorcontrib>Yamanouchi, Dai, MD</creatorcontrib><creatorcontrib>Hoch, John R., MD</creatorcontrib><creatorcontrib>Acher, Charles W., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gupta, Prateek K., MD</au><au>Engelbert, Travis L., MD</au><au>Ramanan, Bala, MBBS</au><au>Fang, Xiang, PhD</au><au>Yamanouchi, Dai, MD</au><au>Hoch, John R., MD</au><au>Acher, Charles W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postdischarge outcomes after endovascular abdominal aortic aneurysm repair</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>59</volume><issue>4</issue><spage>903</spage><epage>908</epage><pages>903-908</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Objective Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. The objective of this study was to examine postdischarge 30-day outcomes after elective EVAR. Methods Patients who underwent an elective EVAR for AAA (n = 11,229) were identified from the American College of Surgeons 2005-2010 National Surgical Quality Improvement Project database. Univariable and multivariable logistic regression analyses were performed. Results The median length of hospital stay was 2 days (interquartile range, 1-3 days). Overall 30-day mortality was 1.0% (n = 117), with 31% (n = 36) of the patients dying after discharge. Overall 30-day morbidity was 10.7% (n = 1204), with 40% (n = 500) of the morbidities being postdischarge. The median time of death and complication was 9 and 3 days, respectively, after surgery. Eighty-eight percent of the wound infections (n = 205 of 234), 33% of pneumonia (n = 44 of 133), and 55% of venous thromboembolism (n = 36 of 65) were postdischarge. Multivariable analyses showed age, congestive heart failure, admission from nursing facility, postoperative pneumonia, myocardial infarction, and renal failure were independently associated with postdischarge mortality, and peripheral arterial disease, female gender, previous cardiac surgery, age, smoking, and diabetes with postdischarge morbidity ( P  &lt; .05 for all). Conclusions Patient characteristics associated with a higher risk for postdischarge adverse events after EVAR were identified. Whether improved predischarge surveillance and close postdischarge follow-up of identified high-risk patients will further improve 30-day outcomes after EVAR needs to be prospectively studied.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24360236</pmid><doi>10.1016/j.jvs.2013.10.057</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Chi-Square Distribution
Databases, Factual
Elective Surgical Procedures
Endovascular Procedures - adverse effects
Endovascular Procedures - mortality
Female
Humans
Length of Stay
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Patient Discharge
Postoperative Complications - mortality
Postoperative Complications - therapy
Registries
Risk Factors
Surgery
Time Factors
Treatment Outcome
United States
title Postdischarge outcomes after endovascular abdominal aortic aneurysm repair
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