Timing of Complications After Endovascular Abdominal Aortic Aneurysm Repair: Are Same Day Procedures Feasible?
Emily Lagergren, MD, Guillermo Escobar, MD, Yazan Duwayri, MD, William Jordan Jr, MD, Ravi Rajani, MD, Jaime Benarroch-Gampel, MD.
Emory University, Atlanta, GA, USA.
Timing of Complications After Endovascular Abdominal Aortic Aneurysm Repair: Are Same Day Procedures Feasible?
BACKGROUND: Recent single center studies demonstrate favorable outcomes with outpatient endovascular abdominal aneurysm repair (EVAR). This study evaluates whether this practice is supported by multicenter prospectively collected data.
METHODS: Patients who underwent elective EVAR (N=7,128) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2010-2012). Postoperative day (POD) of discharge and timing of complications (wound-related, cardiac events, blood transfusion, thromboembolic events, renal insufficiency, stroke, graft failure, reintubation, reoperations, or death) were examined.
RESULTS: In our study population, 3,776 (53%) patients were discharged on POD#1 and 1801 (25.3%) were discharged on POD#2. A total of 874 (12.3%) patients had one or more complications within 30 days of EVAR. In the first 24 hours after EVAR, 433 patients (6.1%) required intraoperative/postoperative blood transfusions, while only 0.3% of patients required reoperation for bleeding. Additionally, 0.41% required unplanned reintubation, 0.37% experienced cardiac events and 0.34% underwent reoperation for limb ischemia. Other complications, such as graft failure, wound complications, thromboembolic events, renal failure, or death were rare (<0.1%) during the first 24hrs. Although not statistically significant, there was a trend towards fewer post-discharged complications in patients who were discharged on POD#1 compared to those discharged on POD#2 (3.8% Vs 4.9%, P=0.05).
CONCLUSION: Our study demonstrates that other than blood transfusion, complications after EVAR were very uncommon in the first 24 hours. Although not significant, we found less complications in patients discharged on POD#1. It's possible that same day discharge after EVAR could be safe, in patients properly identified to be at low risk for bleeding.
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