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Short Stay EVAR is Safe and Cost Effective.

Sarah E Shaw¹, Ryan Preece¹, Katherine M Stenson¹

¹St George's Vascular Institute, St George's Hospital, London, UK.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery

|November 17, 2018

Summary

Selected patients can safely undergo endovascular aneurysm repair (EVAR) with a short stay pathway. Monitoring for 6 hours post-operatively is sufficient, leading to significant cost savings and bed day reductions.

Keywords:

Abdominal aortic aneurysm Day case Endovascular aneurysm repair Length of stay Short stay

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Area of Science:

Vascular Surgery
Health Services Research
Minimally Invasive Procedures

Background:

Reducing length of stay (LOS) post-surgery can optimize resource utilization.
Endovascular aneurysm repair (EVAR) has low morbidity, suggesting potential for short-stay interventions.

Purpose of the Study:

To systematically review the safety, feasibility, and cost-effectiveness of a short-stay EVAR pathway.

Main Methods:

Systematic literature search of Ovid MEDLINE and Embase databases (1996-2018).
Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Bias assessment using the Newcastle-Ottawa Scale.

Main Results:

Five studies including 450 patients showed 75% were discharged same or next day post-EVAR.
Complications typically occurred within 3-6 hours; readmission rates were 0-5% with no difference in 30-day readmissions.
Early discharge resulted in significant cost savings (£9844 for 1-day LOS vs. £13,360 for 4-day LOS).

Conclusions:

Selected patients can safely undergo EVAR on a short-stay pathway.
A 6-hour post-operative monitoring period is adequate for low-risk patients.
Reducing UK EVAR LOS to 1.5 days could save ~£1.8 million annually and free 4361 bed days.