A Novel Preoperative Risk Score to Identify Patients at High Risk for Nonhome Discharge after Elective Open Abdominal...

Area of Science:

• Vascular Surgery
• Health Services Research
• Patient Outcomes

Background:

• Nonhome discharge (NHD) after vascular surgery impacts patient quality of life, outcomes, and healthcare costs.
• Predicting NHD is crucial for preoperative counseling and shared decision-making, especially for abdominal aortic aneurysm (AAA) repair.
• Postoperative course varies significantly between open and endovascular AAA repair techniques.

Purpose of the Study:

• Identify independent predictors of NHD following elective open abdominal aortic aneurysm repair (OAR).
• Develop a clinically useful preoperative risk score for NHD after OAR.

Main Methods:

• Utilized data from the Society for Vascular Surgery Vascular Quality Initiative (2013-2022) for elective OAR cases.
• Developed a risk score using multivariable logistic regression on two-thirds of the data, then validated it on the remaining third.
• Assessed model performance using c-statistics.

Main Results:

• 18.2% of 8,274 patients required NHD.
• Key predictors included age ≥80, non-ambulatory status, proximal clamp location, anemia, COPD, female sex, hypertension, and ASA class ≥4.
• A 14-point risk score stratified patients into low (9.9% NHD), moderate (25.5% NHD), and high (44.6% NHD) risk groups, with good predictive ability (c-statistic=0.73).

Conclusions:

• A novel risk score effectively predicts NHD after elective OAR.
• The score uses preoperatively identifiable characteristics, facilitating improved risk assessment.
• Implementation can enhance preoperative counseling and shared decision-making for patients undergoing OAR.