Samantha Durbin MD , Amir Azarbal MD , Enjae Jung MD , Harish Krishnamoorthi MD , Khanh Nguyen MD , Matthew C. Koopmann MD
{"title":"择期开放动脉手术后当天出院","authors":"Samantha Durbin MD , Amir Azarbal MD , Enjae Jung MD , Harish Krishnamoorthi MD , Khanh Nguyen MD , Matthew C. Koopmann MD","doi":"10.1016/j.jvsvi.2024.100064","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the feasibility of same-day discharge (SDD) after open peripheral arterial surgery (OAS) in a veteran population.</p></div><div><h3>Methods</h3><p>This is a single-center, retrospective study. Starting September 2021, veterans who underwent elective OAS were selectively chosen for planned SDD. Eligible procedures included popliteal artery aneurysm repair, common femoral/superficial femoral/popliteal artery endarterectomy ± concurrent endovascular intervention, bypass graft revision, femoral-femoral bypass, and axillofemoral bypass. All patients who underwent eligible procedures were compared across three eras based on the primary location of postoperative admission: intensive care unit era (ICUE, September 2016-December 2018), inpatient ward era (WARDE, January 2019-August 2021), and SDD era (SDDE, September 2021-December 2022). Demographics, comorbidities, indication for procedures, operative times, complications, readmissions, and length of stay (LOS) were analyzed.</p></div><div><h3>Results</h3><p>Ninety-nine male patients underwent eligible procedures during the 6-year study period (ICUE: 32, WARDE; 41, and SDDE: 26). ICUE had higher rates of tobacco use (<em>P</em> = .04) with no differences in age or other comorbidities between the eras. Indications were claudication, bypass graft stenosis, popliteal aneurysm, ischemic rest pain, and tissue loss. Twenty patients were selected for SDD, and 18 were successfully discharged same day. Operative times were not significantly different between the eras. SDDE patients were more likely to undergo monitored anesthesia care (<em>P</em> = .04). The mean LOS was significantly lower in SDDE (0.54 days, <em>P</em> < .001) compared with WARDE (2.9 days) and ICUE (2.8 days). The mean ICU LOS was lower in SDDE (0.2 days, <em>P</em> <.001) compared with ICUE (1.1 days). There was no difference in postoperative complications (<em>P</em> = .30), reoperation (<em>P</em> = .51), or readmission rates (<em>P</em> = .35).</p></div><div><h3>Conclusions</h3><p>SDD is safe and feasible after elective OAS in a veteran population with a low unplanned admission rate.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000126/pdfft?md5=19fc101470b7e84bf6e0b028892290cf&pid=1-s2.0-S2949912724000126-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Same-day discharge after elective open arterial surgery\",\"authors\":\"Samantha Durbin MD , Amir Azarbal MD , Enjae Jung MD , Harish Krishnamoorthi MD , Khanh Nguyen MD , Matthew C. Koopmann MD\",\"doi\":\"10.1016/j.jvsvi.2024.100064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To evaluate the feasibility of same-day discharge (SDD) after open peripheral arterial surgery (OAS) in a veteran population.</p></div><div><h3>Methods</h3><p>This is a single-center, retrospective study. Starting September 2021, veterans who underwent elective OAS were selectively chosen for planned SDD. Eligible procedures included popliteal artery aneurysm repair, common femoral/superficial femoral/popliteal artery endarterectomy ± concurrent endovascular intervention, bypass graft revision, femoral-femoral bypass, and axillofemoral bypass. All patients who underwent eligible procedures were compared across three eras based on the primary location of postoperative admission: intensive care unit era (ICUE, September 2016-December 2018), inpatient ward era (WARDE, January 2019-August 2021), and SDD era (SDDE, September 2021-December 2022). Demographics, comorbidities, indication for procedures, operative times, complications, readmissions, and length of stay (LOS) were analyzed.</p></div><div><h3>Results</h3><p>Ninety-nine male patients underwent eligible procedures during the 6-year study period (ICUE: 32, WARDE; 41, and SDDE: 26). ICUE had higher rates of tobacco use (<em>P</em> = .04) with no differences in age or other comorbidities between the eras. Indications were claudication, bypass graft stenosis, popliteal aneurysm, ischemic rest pain, and tissue loss. Twenty patients were selected for SDD, and 18 were successfully discharged same day. Operative times were not significantly different between the eras. SDDE patients were more likely to undergo monitored anesthesia care (<em>P</em> = .04). The mean LOS was significantly lower in SDDE (0.54 days, <em>P</em> < .001) compared with WARDE (2.9 days) and ICUE (2.8 days). The mean ICU LOS was lower in SDDE (0.2 days, <em>P</em> <.001) compared with ICUE (1.1 days). There was no difference in postoperative complications (<em>P</em> = .30), reoperation (<em>P</em> = .51), or readmission rates (<em>P</em> = .35).</p></div><div><h3>Conclusions</h3><p>SDD is safe and feasible after elective OAS in a veteran population with a low unplanned admission rate.</p></div>\",\"PeriodicalId\":74034,\"journal\":{\"name\":\"JVS-vascular insights\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2949912724000126/pdfft?md5=19fc101470b7e84bf6e0b028892290cf&pid=1-s2.0-S2949912724000126-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JVS-vascular insights\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2949912724000126\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JVS-vascular insights","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2949912724000126","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Same-day discharge after elective open arterial surgery
Objective
To evaluate the feasibility of same-day discharge (SDD) after open peripheral arterial surgery (OAS) in a veteran population.
Methods
This is a single-center, retrospective study. Starting September 2021, veterans who underwent elective OAS were selectively chosen for planned SDD. Eligible procedures included popliteal artery aneurysm repair, common femoral/superficial femoral/popliteal artery endarterectomy ± concurrent endovascular intervention, bypass graft revision, femoral-femoral bypass, and axillofemoral bypass. All patients who underwent eligible procedures were compared across three eras based on the primary location of postoperative admission: intensive care unit era (ICUE, September 2016-December 2018), inpatient ward era (WARDE, January 2019-August 2021), and SDD era (SDDE, September 2021-December 2022). Demographics, comorbidities, indication for procedures, operative times, complications, readmissions, and length of stay (LOS) were analyzed.
Results
Ninety-nine male patients underwent eligible procedures during the 6-year study period (ICUE: 32, WARDE; 41, and SDDE: 26). ICUE had higher rates of tobacco use (P = .04) with no differences in age or other comorbidities between the eras. Indications were claudication, bypass graft stenosis, popliteal aneurysm, ischemic rest pain, and tissue loss. Twenty patients were selected for SDD, and 18 were successfully discharged same day. Operative times were not significantly different between the eras. SDDE patients were more likely to undergo monitored anesthesia care (P = .04). The mean LOS was significantly lower in SDDE (0.54 days, P < .001) compared with WARDE (2.9 days) and ICUE (2.8 days). The mean ICU LOS was lower in SDDE (0.2 days, P <.001) compared with ICUE (1.1 days). There was no difference in postoperative complications (P = .30), reoperation (P = .51), or readmission rates (P = .35).
Conclusions
SDD is safe and feasible after elective OAS in a veteran population with a low unplanned admission rate.
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