目的:本研究旨在确定与血管内动脉瘤修复术(EVAR)后非家庭出院(NHD)相关的术前因素。NHD对病人护理有影响,重新接纳,和长期死亡率;尽管如此,现有文献缺乏有关EVAR患者与NHD相关因素的信息。相比之下,本研究利用来自血管质量倡议(VQI)的国家数据,评估了该人群与NHD相关的术前因素.
方法:我们确定了在VQI(2003-2022)中接受选择性EVAR的成年患者,并排除了术前不在家的患者。采用多变量logistic回归分析与NHD相关的术前因素。使用Kaplan-Meier方法和Cox回归分析来评估作为次要结果的NHD对5年生存率的影响。
结果:纳入61,792例患者,其中3,155(5.1%)患有NHD。NHD患者年龄较大(79[73-18]岁与73[67-79]年),女性(33.7%vs.18.2%;P<.001),非白人(16.0%与11.7%;P<.001)并有更多的合并症。NHD患者术后并发症发生率较高(急性肾损伤:11.9%vs.2.0%;P<.001,心肌梗死:3.8%vs.0.5%;P<.001,院内再干预:4.7%vs.0.5%;P=0.033)。多变量分析显示,许多术前特征与较高的NHD几率相关:最值得注意的是,年龄(每增加十年:OR=2.15,95%CI:2.03-2.28;P<.001),女性(OR=1.79,95%CI:1.63-1.95;P<.001)和动脉瘤直径>65mm(OR=2.18,95%CI:1.98-2.39;P<.001),以及可能改变的因素,包括:贫血,COPD,CHF,体重,和糖尿病。相比之下,阿司匹林,他汀类药物和ACE抑制剂/ARB的使用与较低的NHD几率相关。NHD与较高的5年死亡率相关,即使在调整了混杂因素后(40%与14%,aHR=2.13,95%CI:1.86-2.44;P<.001)。
结论:一些因素与选择性EVAR后发生NHD的几率更高相关,包括不可改变的因素,如女性和较大的主动脉直径,和可能改变的因素,如贫血,COPD,CHF,BMI,和糖尿病。应特别注意具有不可改变因素的人群,努力优化具有更高NHD可能性的医疗条件似乎适合改善EVAR后患者的预后和生活质量。
OBJECTIVE: This study aims to identify preoperative factors associated with non-home discharge (NHD) after endovascular aneurysm repair (EVAR). NHD has implications for patient care, readmission, and long-term mortality; nevertheless, existing literature lacks information regarding factors associated with NHD for patients undergoing EVAR. In contrast, our study assesses preoperative factors associated with NHD for this population by utilizing national data from the Vascular Quality Initiative (VQI).
METHODS: We identified adult patients who underwent elective EVAR in the VQI (2003-2022) and excluded those who were not living at home preoperatively. Multivariable logistic regression was used to identify preoperative factors associated with NHD. Kaplan-Meier methods and Cox-regression analyses were used to assess the impact of NHD on 5-year survival as a secondary outcome.
RESULTS: 61,792 patients were included, of which 3,155 (5.1%) had NHD. NHD patients were more likely to be older (79 [73-18] years vs. 73[67-79] years), female (33.7% vs. 18.2%; P<.001), non-white (16.0% vs. 11.7%; P<.001) and have more comorbidities. NHD patients 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 in-hospital 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: OR=2.15, 95% CI:2.03-2.28; P<.001), female sex (OR=1.79, 95% CI:1.63-1.95; P<.001) and aneurysm diameter >65mm (OR=2.18, 95% CI:1.98-2.39; P<.001), along with potentially modifiable factors including: anemia, COPD, CHF, weight, and diabetes. In contrast, aspirin, statin, and ACE-inhibitor/ARB usage were associated with lower odds of NHD. NHD was associated with higher hazards of 5-year mortality, even after adjusting for confounders (40% vs. 14%, aHR=2.13, 95% CI:1.86-2.44; P<.001).
CONCLUSIONS: 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.