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Comprehensive Evaluation of Common Open and Endovascular Procedures and Their Relationship with Postdischarge Complications

  • Ruojia Debbie Li
    Affiliations
    Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

    Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, IL
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  • Matthew C. Chia
    Affiliations
    Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

    Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, IL
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  • Mark K. Eskandari
    Correspondence
    Correspondence to: Mark K. Eskandari, MD, Division of Vascular Surgery, Northwestern Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA
    Affiliations
    Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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      Background

      Percutaneous endovascular treatment for arterial vascular diseases has revolutionized vascular care. While these procedures offer improved morbidity, mortality, and length of stay (LOS), their effect on postdischarge complications is unknown. The objectives of the study were to evaluate trends in LOS and postdischarge complications over time and to assess factors associated with postdischarge complications.

      Methods

      Patients who underwent surgery for common vascular pathologies (abdominal aortic aneurysm, aortoiliac occlusive disease, lower extremity disease, and carotid stenosis) were identified from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted database (2014–2019). Outcomes included LOS, 30-day complications, and proportions of postdischarge complications. Predictors of postdischarge complications were assessed using a multivariable logistic regression.

      Results

      Of 80,311 patients evaluated, median LOS did not change from 2014 to 2019 (2, interquartile range 1–5). Overall, 15.7% of patients experienced any 30-day complication, with 31.3% occurring after discharge. The proportion of postdischarge complications increased from 29.1% (2014) to 35.9% (2019), P < 0.001. With exception of carotid procedures, endovascular procedures had lower overall complication rates than open procedures; however, there was an increased proportion of postdischarge complications for endovascular procedures (all P < 0.001). Factors associated with an increased odds of postdischarge complications included female, Black or other race, dependent functional status, underweight or obesity, increased LOS, and procedural time, all P < 0.05.

      Conclusions

      Across 4 representative common vascular pathologies, endovascular treatments had a higher proportion of postdischarge complications compared to open procedures. Early identification and evaluation of postdischarge complications for endovascular patients may be warranted to avoid unplanned readmission.
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