Factors Associated with Nonhome Discharge After Endovascular Aneurysm Repair

Non-home discharge (NHD) has implications for patient care, readmission, and long-term mortality; nevertheless, existing literature lacks information regarding factors associated with NHD for patients undergoing endovascular aneurysm repair (EVAR). This study aims to identify preoperative factors associated with NHD after EVAR. We identified adult patients who underwent elective EVAR in the Vascular Quality Initiative (2003-2022) and excluded those who were not living at home preoperatively. Multivariable logistic regression was used to identify preoperative factors associated with NHD. A sensitivity analysis was performed among patients without reported postoperative complications to rule out the possibility of postoperative complications driving discharge status. Kaplan-Meier methods and Cox regression analyses were conducted to assess the impact of NHD on 5-year survival. A total of 61,792 patients were included, of which 3155 (5.1%) had NHD. NHD patients were more likely to be older (79 years; interquartiler range, 73-18 years vs 73 years; interquartile range, 67-79 years), female (33.7% vs 18.2%; P < .001), non-White (16.0% vs 11.7%; P < .001), and have more comorbidities. Patients with NHD had higher rates of postoperative complications (acute kidney injury: 11.9% vs 2.0%; P < .001, myocardial infarction: 3.8% vs 0.5%; P < .001, and reintervention: 4.7% vs 0.5%; P = .033). Multivariable analysis revealed many preoperative characteristics were associated with higher odds of NHD: most notably, age (per additional decade: odds ratio [OR], 2.14; 95% confidence interval [CI],1.95-2.37; P < .001), female sex (OR, 1.62; 95% CI,1.40-1.88; P < .001), and aneurysm diameter >65 mm (OR, 2.03; 95% CI, 1.73-2.38; P < .001), along with potentially modifiable factors including: anemia, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), weight, and diabetes (Table I). On the other hand, aspirin, statin, and angiotensin-converting enzyme (ACE)-inhibitor/angiotensin receptor blocker (ARB) usage were associated with lower odds of NHD. In the sensitivity analysis model, NHD remained significantly associated with age, sex, aneurysm diameter, anemia, COPD, CHF, weight, diabetes, aspirin, statin, and ACE-inhibitor/ARB, displaying comparable effect sizes to those observed in the original model. The analysis of long-term survival indicated that NHD was associated with higher hazards of 5-year mortality (40% vs 14%; adjusted hazard ratio, 2.13, 95% CI, 1.86-2.44; P < .001). Several factors were associated with higher odds of NHD following elective EVAR, including non-modifiable factors such as female sex and larger aortic diameter, and potentially modifiable factors such as anemia, COPD, CHF, BMI, and diabetes. Special attention should be given to populations with non-modifiable factors, and efforts at optimizing medical conditions with higher NHD likelihood seems appropriate to improve patient outcomes and quality of life after EVAR.TablePreoperative factors associated with non-home discharge in endovascular aneurysm repair (EVAR) patientsEntire patient populationPatients without postoperative complicationsaOR95% CIP-valueaOR95% CIP-valueAge (per additional decade)2.141.95-2.37<.0012.141.98-2.31<.001Female1.621.40-1.88<.0011.751.55-1.96<.001White0.740.62-0.90.0020.790.69-0.92.002BMI category, kg/m2 Normal (18.5-25)–––– Underweight (<18.5)1.521.12-2.03.0061.41.08-1.78.008 Overweight (25-30)0.850.72-0.99.0420.80.70-0.91<.001 Obese (30-40)0.930.77-1.12.40.910.79-1.06.2 Morbidly obese (≥ 40)1.581.09-2.23.0131.871.41-2.44<.001Diabetes1.251.06-1.47.0081.271.12-1.45<.001Prior myocardial infarction1.090.92-1.28.31.090.95-1.24.2CHF1.421.18-1.70<.0011.41.21-1.61<.001Current smoker0.860.69-1.07.210.84-1.19>.9COPD1.531.33-1.77<.0011.371.23-1.54<.001Renal function eGFR, ml/min/1.73 m2 ≥ 45–––– 30-451.050.87-1.27.60.860.76-0.97.01 <301.331.05-1.68.0140.920.74-1.13.4 Preoperative dialysis1.450.42-3.76.51.480.51-3.41.4Anemia (<10 g/dL)2.552.07-3.12<.0012.922.48-3.43<.001Aspirin0.80.69-0.92.0020.860.77-0.96.008Statin0.850.73-0.99.030.790.70-0.89<.001Beta blocker1.070.93-1.24.31.110.99-1.24.08Prior ACE-inhibitor/ARB0.860.75-0.98.030.780.70-0.87<.001Anticoagulant1.080.90-1.29.41.221.06-1.40.005Center volume Medium (20%-80%)–––– Low (<20%)0.920.77-1.10.40.920.80-1.06.2 High (>80%)1.070.91-1.26.41.130.98-1.28.08AAA diameter >65 mm2.031.73-2.38<.0012.312.04-2.61<.001AAA, Abdominal aortic aneurysm; ACE, angiotensin-converting enzyme; aOR, adjusted odds ratio; ARB, angiotensin receptor blocker; BMI, body mass index; CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; eGFR, estimated glomular filtration rate.Reference: home discharge. Open table in a new tab