Casillas-Berumen Sergio, Rojas-Miguez Florencia A, Farber Alik, Komshian Sevan, Kalish Jeffrey A, Rybin Denis, Doros Gheorghe, Siracuse Jeffrey J
1 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Vasc Endovascular Surg. 2018 Jan;52(1):5-10. doi: 10.1177/1538574417739747. Epub 2017 Nov 9.
Open aortic aneurysm repair (AAA) repair can be resource intensive and associated with a prolonged length of stay (LOS). We sought to examine patient and aneurysm predictors of prolonged LOS to better identify those at risk in the preoperative setting.
Patient data were obtained from the targeted AAA American College of Surgery National Surgical Quality Improvement Program database from 2012 to 2014 of patients undergoing open AAA repair. Multivariable logistic regression was used to determine predictors of prolonged postoperative LOS defined as greater than 10 days (75th percentile).
There were 1172 open AAA repairs identified. The majority (54%) of patients were older than 70 years and male (74%). Surgical approach was transperitoneal (70.9%) and retroperitoneal (29.1%). Aneurysms were 51.4% infrarenal, 33% juxtarenal, 5.7% pararenal, 7.4% suprarenal, and 2.5% type IV thoracoabdominal. Mean and median LOS were 9.1 ± 7.4 and 7 (0-72) days, respectively. Independently associated with extended LOS factors were visceral revascularization (odds ratio [OR]: 5.32, 95% confidence interval [CI]: 2.77-10.22, P < .001), type IV thoracoabdominal extent (OR: 3.09, 95% CI: 1.01-9.46, P = .048), suprarenal extent (OR: 1.89, 95% CI: 1.07-3.34, P = .029) and juxtarenal (OR: 1.43, 95% CI: 1.01-2.02, P = .004), non-Caucasian race (OR: 2.80, 95% CI: 1.77-4.41, P < .001), chronic obstructive pulmonary disease (OR: 1.76, 95% CI: 1.20-2.59, P = .004), not-from-home admission (OR: 1.91, 95% CI: 1.13-3.24), and age greater than 70 (OR: 1.49, 95% CI: 1.08-2.05, P = .014).
We identified patient and aneurysm characteristics independently associated with protracted LOS following open AAA repair. Prospective identification of high-risk patients may allow physicians and hospitals to engage in multidisciplinary collaborations preoperatively to try to improve LOS in this resource-intensive population.
开放性腹主动脉瘤修复术（AAA）资源消耗大，且住院时间（LOS）延长。我们试图研究住院时间延长的患者和动脉瘤预测因素，以便在术前更好地识别有风险的患者。
患者数据来自2012年至2014年接受开放性AAA修复术患者的美国外科医师学会国家外科质量改进计划目标AAA数据库。多变量逻辑回归用于确定术后住院时间延长（定义为超过10天，第75百分位数）的预测因素。
共确定1172例开放性AAA修复术。大多数（54%）患者年龄超过70岁，男性（74%）。手术方式为经腹（70.9%）和腹膜后（29.1%）。动脉瘤位于肾下的占51.4%，近肾的占33%，肾旁的占5.7%，肾上腺上的占7.4%，IV型胸腹主动脉瘤占2.5%。平均住院时间和中位数住院时间分别为9.1±7.4天和7（0 - 72）天。与住院时间延长独立相关的因素有内脏血管重建（比值比[OR]：5.32，95%置信区间[CI]：2.77 - 10.22，P <.001）、IV型胸腹主动脉瘤范围（OR：3.09，95% CI：1.01 - 9.46，P =.048）、肾上腺上范围（OR：1.89，95% CI：1.07 - 3.34，P =.029）和近肾（OR：1.43，95% CI：1.01 - 2.02，P =.004）、非白种人（OR：2.80，95% CI：1.77 - 4.41，P <.001）、慢性阻塞性肺疾病（OR：1.76，95% CI：1.20 - 2.59，P =.004）、非本地入院（OR：1.91，95% CI：1.13 - 3.24）以及年龄大于70岁（OR：1.49，95% CI：1.08 - 2.05，P =.014）。
我们确定了开放性AAA修复术后与住院时间延长独立相关的患者和动脉瘤特征。对高危患者进行前瞻性识别可能使医生和医院在术前开展多学科合作，以试图改善这一资源消耗大人群的住院时间。
