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

Decreasing hospital length of stay (LOS) after surgery improves costs and resource utilization. We evaluated the safety and efficacy of the same-day discharge (SDD) after endovascular aortic aneurysm repair (EVAR) in a Veterans Affairs (VA) population.

We reviewed all EVARs between 2018 and 2024 at a single VA hospital. A protocol was instituted in January 2021 allowing SDD after EVAR for infrarenal aortic or iliac artery aneurysms in patients with an available caregiver for the first 24 hr postoperatively. The exclusion criteria included in-hospital anticoagulation bridging, urgent/emergent repair, anticipated operative time> 6 hr, or a concomitant procedure requiring admission. All patients who met the above criteria were divided into 2 groups: SDD and INPT (patients who had a planned admission due to surgeon preference or unavailability of a caregiver). Study end points included LOS, 30-day ED visits, complication and readmission rates, and 30-day mortality.

A total of 192 patients were included in the study with 49 (25.5%) planned for SDD. Patients were predominantly male (98.9%) and White (92.2%) with a mean age of 74.8 ± 7 years. Demographics and comorbidities were similar between the groups except for a higher rate of diabetes (30.8% vs. 16.3%, P = 0.05) and chronic obstructive pulmonary disease (48.2% vs. 30.6%, P = 0.03) in the INPT group. SDD patients had higher rates of local anesthesia with monitored anesthesia care when compared to their INPT counterparts (57.1% vs. 21%, P < 0.001). SDD had lower rates of planned adjuncts (18.4% vs. 36.6%, P = 0.02) but similar rates of unplanned adjuncts (10.2% vs. 18.9%, P = 0.16). LOS was significantly shorter in the SDD group when compared to the INPT group (0.1 ± 0.4 days vs. 2.1 ± 2 days, P < 0.001) with an 8.5% unplanned admission rate. There were no differences in complications (15.2% vs. 17.7%, P = 0.69), ED visits (19.6% vs. 16.3%, P = 0.61), readmissions (10.6% vs. 8.5%, P = 0.66), or mortality (0% vs. 1.4%, P = 0.4) at 30 days between the SDD and INPT groups, respectively.

SDD after EVAR is feasible in a VA population with reduced LOS without increased risk of complication or readmission. Larger multicenter studies should be performed prior to VA-wide adoption of this strategy.