Factors Affecting Longer Stay and Higher Costs during Elective Open Repair for Abdominal Aortic Aneurysm: A Case-Control Study.
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal
/ diagnostic imaging
Blood Transfusion
/ economics
Elective Surgical Procedures
Female
Hospital Costs
Humans
Length of Stay
/ economics
Male
Operative Time
Outcome and Process Assessment, Health Care
/ economics
Postoperative Complications
/ mortality
Recovery of Function
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures
/ adverse effects
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
20
11
2018
revised:
05
03
2019
accepted:
28
03
2019
pubmed:
16
6
2019
medline:
24
12
2019
entrez:
16
6
2019
Statut:
ppublish
Résumé
Open surgery for abdominal aortic aneurysm (AAA) has the advantage of requiring less reintervention compared with endovascular aneurysm repair. The reduction of the initial hospitalization costs can provide socioeconomic benefits. The objective of this study was to determine the factors associated with an increase in the length of hospital stay and costs of open surgery for AAA. A total of 579 consecutive patients who underwent open surgery for intact AAA and survived, between 1998 and 2015 at Asahi General Hospital in Japan, were included in the analysis. Patients' characteristics, aneurysm morphology, operative procedures, postoperative complications, and postoperative courses were analyzed in relation to the hospital length of stay and costs. Patients with longer stays or higher costs (exceeding the third quartile) were compared with those with stays or costs no more than the third quartile. The mean patient age was 75 ± 8 years, and 492 patients (85%) were male, with a mean aortic diameter of 57 ± 10 mm. The mean operation time was 214 ± 56 min with an estimated mean blood loss of 444 ± 305 g. Transfusion was required in 28 patients (4.8%) and return to the operating room (RTOR) in 18 patients (3.1%). The median postoperative hospital stay was 7 (7-8) days. Median costs of hospitalization were 12,300 (11,800-13,100) United States Dollar. In the multivariate analysis, the major factors which increased the length of stay were transfusion, late ambulation, and prolonged fasting time. Major risk factors for higher total hospitalization costs were transfusion, RTOR, and longer fasting time. Regardless of the patients' comorbidities or aneurysm morphology, avoidance of transfusion and RTOR, combined with early ambulation and enteral feeding in the postoperative care, can reduce the length of stay and total hospitalization costs associated with open surgery for AAA.
Sections du résumé
BACKGROUND
BACKGROUND
Open surgery for abdominal aortic aneurysm (AAA) has the advantage of requiring less reintervention compared with endovascular aneurysm repair. The reduction of the initial hospitalization costs can provide socioeconomic benefits. The objective of this study was to determine the factors associated with an increase in the length of hospital stay and costs of open surgery for AAA.
METHODS
METHODS
A total of 579 consecutive patients who underwent open surgery for intact AAA and survived, between 1998 and 2015 at Asahi General Hospital in Japan, were included in the analysis. Patients' characteristics, aneurysm morphology, operative procedures, postoperative complications, and postoperative courses were analyzed in relation to the hospital length of stay and costs. Patients with longer stays or higher costs (exceeding the third quartile) were compared with those with stays or costs no more than the third quartile.
RESULTS
RESULTS
The mean patient age was 75 ± 8 years, and 492 patients (85%) were male, with a mean aortic diameter of 57 ± 10 mm. The mean operation time was 214 ± 56 min with an estimated mean blood loss of 444 ± 305 g. Transfusion was required in 28 patients (4.8%) and return to the operating room (RTOR) in 18 patients (3.1%). The median postoperative hospital stay was 7 (7-8) days. Median costs of hospitalization were 12,300 (11,800-13,100) United States Dollar. In the multivariate analysis, the major factors which increased the length of stay were transfusion, late ambulation, and prolonged fasting time. Major risk factors for higher total hospitalization costs were transfusion, RTOR, and longer fasting time.
CONCLUSIONS
CONCLUSIONS
Regardless of the patients' comorbidities or aneurysm morphology, avoidance of transfusion and RTOR, combined with early ambulation and enteral feeding in the postoperative care, can reduce the length of stay and total hospitalization costs associated with open surgery for AAA.
Identifiants
pubmed: 31201977
pii: S0890-5096(19)30407-8
doi: 10.1016/j.avsg.2019.03.039
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
112-119Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.