Impact of Length of Stay on Long-term Survival After Carotid Endarterectomy
Samantha D. Minc, MD, Sari D. Holmes, PhD, Yue Ren, MS, Luke Marone, MD.
West Virginia University, Morgantown, WV, USA.
Recommendations to avoid lengths of stay longer than one day after carotid endarterectomy (CEA) have focused on the financial benefits of this practice as well as patient satisfaction, but the impact on long-term survival remains unclear. The purpose of this study was to examine the impact of shorter length of stay on long-term survival after CEA in a large national sample.
The Vascular Quality Initiative (VQI) national database for CEA comprised the sample for these analyses (N=84,570). Patients with outlier values on survival days and those who died during hospitalization were excluded. Length of stay was categorized into two groups: LOS ≤1 day (67%) and LOS >1 day (33%). Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were conducted to examine the effect of length of stay on survival.
The mean age of this sample was 70.3 ± 9.5 years with 40% female patients. Mean follow-up was 1109.5 ± 904.5 days. Patients with LOS >1 were older (71.1 vs. 69.9 years, P < 0.001) and were more likely to have comorbid conditions, such as diabetes (40% vs. 33%, P < 0.001), COPD (25% vs. 21%, P < 0.001), and CAD (32% vs. 26%, P < 0.001). Unadjusted survival analysis found that patients with LOS >1 day had reduced survival (64% vs. 70%, Log Rank = 394.6, P < 0.001). After adjustment for age, gender, elective status, hypertension, diabetes, CHF, COPD, and CAD, the risk for mortality was 38% greater for patients with LOS >1 day (HR = 1.38, 95% CI = 1.31–1.45, P < 0.001; FIGURE).
The results from these analyses of a large national sample indicate that even with adjustment for comorbid conditions and other factors that impact survival, length of stay beyond one day after CEA was associated with a significantly greater mortality risk during follow-up. This finding further supports the recommendation that lengths of stay beyond one day after CEA should be avoided.
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