Factors that predict prolonged length of stay after aortic surgery

In this era of managed health care, third-party payers insist that surgeons minimize hospital stay even after major operations such as aortic surgery. We attempted to identify risk factors that predict prolonged hospital length of stay (LOS) so that realistic expectations can be established for these patients who frequently are at high-risk.

In 1994 a clinical pathway for aortic surgery was implemented at our hospital. Between January 1, 1994, and December 31, 2000, data including identifiable risk factors and LOS were reviewed for 240 patients who underwent elective infrarenal aortic surgery to treat aneurysmal (n = 179) or occlusive (n = 61) disease. Risk factors were analyzed to determine their effect on LOS. Data for patients who underwent endovascular, emergency, or concomitant cardiac surgery were excluded from analysis.

In-hospital mortality was 0.4% (1 of 240 patients), and morbidity was 18% (44 of 240 patients). Mean LOS was 8.2 +/- 5.7 days for all patients, 6.9 +/- 2.9 days for those without complications, and 13.8 +/- 6.7 days for patients with complications (P <.0001). Factors that predicted prolonged LOS (Kaplan-Meier method) included age older than 75 years (P =.0004), chronic obstructive pulmonary disease (COPD; P =.0351), intraoperative blood loss more than 500 mL (P =.0006), duration of surgery more than 5 hours (P <.0001), wound infection (P =.0311), and postoperative complications overall (P <.0001). Remaining factors associated with prolonged LOS (Cox regression analysis) included age older than 75 years (P =.0050), COPD (P =.0445), and complications overall (P =.0094).

The only identifiable preoperative risk factors that correlated with increasing LOS after elective infrarenal aortic surgery (multivariate analysis) were increasing age and COPD. Third-party payers should allow longer hospitalization for patients older than 75 years and for patients with significant pulmonary disease.