Development of novel patient selection criteria for a short stay endovascular aneurysm repair pathway: Improving patient selection for short stay endovascular aneurysm repair
Autor: | James Budge, Ryan Preece, Katherine Stenson, Joseph Wiltshire, Sarah Shaw, Peter J. Holt, Ian M. Loftus, Benjamin O. Patterson, Jorg L. de Bruin |
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Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Time Factors Health Status medicine.medical_treatment Clinical Decision-Making 030204 cardiovascular system & hematology 030230 surgery Patient Readmission Risk Assessment Endovascular aneurysm repair Decision Support Techniques Blood Vessel Prosthesis Implantation 03 medical and health sciences Postoperative Complications 0302 clinical medicine Patient satisfaction Aneurysm Predictive Value of Tests Risk Factors medicine Humans Radiology Nuclear Medicine and imaging Service efficiency Selection (genetic algorithm) Aged Retrospective Studies Aged 80 and over business.industry Patient Selection Endovascular Procedures General Medicine Length of Stay medicine.disease Patient Discharge Abdominal aortic aneurysm Surgery Treatment Outcome Short stay Female Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal |
Zdroj: | Vascular. 28:59-67 |
ISSN: | 1708-539X 1708-5381 |
Popis: | Objectives A short-stay endovascular aneurysm repair (SS-EVAR) pathway for infrarenal abdominal aortic aneurysms offers the potential to improve service efficiency and patient satisfaction by reducing the hospital length of stay. This study aimed to determine whether the implementation of a novel set of patient selection criteria for a theoretical SS-EVAR pathway could facilitate an expansion of the proportion of suitable patients, whilst maintaining patient safety and limiting unplanned emergency readmissions. Methods Two SS-EVAR selection criteria (low and high risk) were generated based upon patient pre-operative comorbidities. The low risk criteria essentially selected fit and healthy individuals, whereas the high risk criteria included patients with a range of comorbidities that could still theoretically enable enrolment onto a SS-EVAR pathway. A retrospective analysis, whereby both criteria were applied to all elective EVARs recorded in the National Vascular Registry between 2013 and 2016 at a single tertiary vascular unit was performed. Rates and timings of postoperative complications, reinterventions and unplanned readmissions for patients meeting each criteria were assessed. Results In total, 188 patients were included (92% male, mean age 75.4 ± 7.2 years). Twenty-nine patients (15%) met the low risk criteria. Two (7%) of these experienced an inpatient complication which were both detected within 24 h of operation (including one who required reintervention), and no patients in this group had an unplanned readmission within 30 days. One-hundred and ten patients (59%) met our high risk criteria and 19 (17%) experienced an inpatient complication, with 4 (4%) of these occurring beyond 24 h post-EVAR (three urinary problems and one acute on chronic kidney injury). Six (6%) of these patients required a reintervention; however, all of these complications were detected within 24 h. Two (2%) high risk cohort patients required unplanned readmission within 30 days for a femoral pseudoaneurysm and musculoskeletal back pain. Conclusions With high risk patient selection criteria and appropriate post-operative safeguards, up to 60% of infrarenal abdominal aortic aneurysms patients could be safely enrolled onto a next-day discharge SS-EVAR pathway with minimal readmissions, thus allowing more effective resource utilisation. |
Databáze: | OpenAIRE |
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