Society For Clinical Vascular Surgery

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Preoperative and Intraoperative Predictors of Length of Stay Following Fenestrated Endovascular Aortic Aneurysm Repair (FEVAR)
Jason R. Cook, MD PhD, Jeffrey Jim, MD MPHS FACS, Luis Sanchez, MD FACS, Senthil N. Jayarajan, MD MS.
Washington University in Saint Louis, Saint Louis, MO, USA.

OBJECTIVES: Fenestrated endovascular aortic aneurysm repairs (FEVAR) are becoming increasingly common for the repair of aortic pathology. The risk factors (RF) that affect postprocedural length of stay (LOS) have not been well described. The goal of our study was to determine the effects of modifiable and non-modifiable RF on LOS following FEVAR.
METHODS: We retrospectively reviewed patients following FEVAR (2012-2015) with a commercially available endograft at a single academic medical center. RFs analyzed included demographics, medical comorbidities, medications and intraoperative outcomes. Chi-square and Wilcoxon Rank-Sum tests were used to identify variables of interest and zero-truncated Poisson regression analysis used to determine the effect of risk factors on LOS.
RESULTS: 97 patients underwent FEVAR during the study period. Two patients that expired during the index hospitalization were excluded from analysis resulting in a study cohort of 95 patients (83% male, median age 74 years [range 53-89]). The median number of fenestrations/scallops was 3 (range 1-3) and number of stents was 2 (range 1-4). Of 40 SMA stents, 13 (33%) were from brachial access. Seven (7.5%) of patients required adjunctive/concomitant procedures. The median LOS was 4 days (range 2-67 days) RFs that did not affect LOS included atrial fibrillation, obesity, hypertension, diabetes, COPD, gender, smoking, and renal/celiac artery stenting. RFs found to increase LOS are listed in Table 1. On multivariate analysis, RF associated with increased LOS included long OR time (42%, p<0.001) or high EBL (29%, p=0.017), SMA stenting (24%, p=0.029), and CAD (50%, p<0.001). Factors associated with reduced LOS included discharge to home (36%, p<0.001) and age greater than the median (41%, p<0.001).

CONCLUSIONS:Our single-center study demonstrates reduced LOS for patients greater than 74 years of age on multivariate analysis, possibly reflecting more stringent screening or effect modification of a non-evaluated RF. Patients undergoing FEVAR have a relatively short LOS, which is impacted by both modifiable surgical factors and medical comorbidities.

Table 1. Univariate analysis of risk factors associated with increased LOS after FEVAR.
Positive or > MedianNegative or < Median
Risk FactorLOS (d)IQRLOS (d)IQRp value
Coronary Artery Disease(CAD)43.693.432.040.039
Brachial Access5.615.873.652.130.027
SMA Stent4.522.073.572.070.038
OR Time3.541.934.673.780.0013
Estimated Blood Loss (EBL)3.451.9643.690.012

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