Same-Day Discharge Following EVAR in Select Veteran Patients is Safe and Effective

Area of Science:

• Vascular Surgery
• Health Services Research

Background:

• Decreasing hospital length of stay (LOS) is crucial for cost reduction and resource optimization in surgical care.
• Endovascular Aneurysm Repair (EVAR) is a common procedure with potential for reduced LOS.
• Evaluating same-day discharge (SDD) safety and efficacy in specific patient populations is essential.

Purpose of the Study:

• To assess the safety and efficacy of same-day discharge (SDD) following endovascular aneurysm repair (EVAR).
• To compare outcomes of SDD versus planned inpatient (INPT) admission after EVAR in a Veterans Affairs (VA) population.
• To determine the impact of SDD on length of stay, complications, readmissions, and mortality.

Main Methods:

• Retrospective review of EVAR procedures performed between 2018 and 2024 at a single VA hospital.
• Implementation of an SDD protocol in January 2021 for specific EVAR cases with caregiver support.
• Comparison of SDD patients with INPT patients based on LOS, 30-day emergency department visits, complication rates, readmission rates, and 30-day mortality.

Main Results:

• Of 192 EVAR patients, 49 (25.5%) were planned for SDD.
• SDD patients had significantly shorter LOS (0.1 vs. 2.1 days) compared to INPT patients (P < 0.001).
• No significant differences were observed in 30-day complication rates, ED visits, readmissions, or mortality between SDD and INPT groups.

Conclusions:

• Same-day discharge (SDD) after EVAR is a feasible strategy within the VA system.
• SDD can reduce hospital length of stay (LOS) without compromising patient safety or increasing adverse events.
• Further multicenter studies are recommended before widespread adoption of SDD for EVAR across the VA system.