A Novel Preoperative Risk Score for Non-Home Discharge After Elective Thoracic Endovascular Aortic Repair. Journal of vascular surgery Ramirez, J. L., Zarkowsky, D. S., Boitano, L. T., Conrad, M. F., Arya, S., Gasper, W. J., Conte, M. S., Iannuzzi, J. C. 2020


INTRODUCTION: Non-home discharge (NHD) to a rehabilitation or skilled nursing facility after vascular surgery is poorly described despite its large impact on patients. Understanding post-surgical NHD risk is essential to providing adequate preoperative counseling and shared decision making, particularly for elective surgeries. We aimed to identify independent predictors of NHD following elective thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysms (TAA) and to create a clinically useful preoperative risk score.METHODS: Elective TEVAR cases for descending TAA were queried from the SVS Vascular Quality Initiative 2014-2018. A risk score was created by splitting the data set into two-thirds for model development and one-third for validation. A parsimonious stepwise hierarchical multivariable logistic regression controlling for hospital level variation was performed in the development dataset, and the beta-coefficients were used to assign points for a risk score. This score was then cross-validated and model performance assessed.RESULTS: Overall, 1,469 patients were included and 213 (14.5%) required NHD. At baseline, patients who required NHD were more likely to be = 80 years old (35.2% vs. 19.4%), female (58.7% vs. 40.6%), functionally dependent (42.3% vs. 24.0%), anemic (46.5% vs. 27.8%), and have chronic obstructive pulmonary disease (41.3% vs. 33.4%), congestive heart failure (18.8% vs. 11.1%), and American Society of Anesthesiologists class = 4 (51.6% vs. 39.8%; all P<0.05). Multivariable analysis in the development group identified independent predictors of NHD, which were used to create an 18-point risk score. Patients were stratified into three groups based upon their risk score: low risk (0-7 points; n=563) with an NHD rate of 4.3%, moderate risk (8-11 points; n=701) with an NHD rate of 17.0%, and high risk (= 12 points; n=205) with an NHD rate of 34.2%. The risk score had good predictive ability with c-statistic=0.75 for model development and c-statistic=0.72 in the validation dataset.CONCLUSIONS: This novel risk score can predict NHD following TEVAR for TAA using characteristics that can be identified preoperatively. Utilization of this score may allow for improved risk assessment, preoperative counseling, and shared decision making.

View details for DOI 10.1016/j.jvs.2020.10.005

View details for PubMedID 33065243