The Majority of Patients Who Survive a Ruptured Abdominal Aortic Aneurysm Repair are Able to Return to Home.

BACKGROUND

Ruptured abdominal aortic aneurysm (rAAA) is a potential life-alerting event and is associated with significant morbidity and mortality. Returning to living at home, a quality outcome, after rAAA is unclear. Our goal was to assess patients undergoing repair for rAAA that survived being able to return to living at home.

METHODS

We analyzed the Vascular Quality Initiative's open and endovascular AAA registry (2003-2022) for rAAA. We analyzed initial discharge destination as well as long-term living situation for those who survived their index hospitalization. Risk adjusted analysis was performed to identify risk factors for not returning to home.

RESULTS

There were 5,272 patients that were discharged alive after repair for rAAA. The average age was 71.5 years, 79% were male sex, and 86.3% unidentified as White race. The majority had Medicare insurance (57.8%) followed by commercial (29.4%). Preoperatively, 97.4% lived at home. Patients that preoperatively lived at home were more likely to be younger, male sex, have commercial insurance, and have medical comorbidities. Patients living at home were more likely to be discharged home and have similar postoperative complications. Of the 5,137 patients that preoperatively lived at home and survived index hospitalization, 62.4% were discharged home after their index hospitalization. There were 2,822 (54.9%) that had long-term follow-up. Of these, 84% were able to return to home. There were 22.2% of the discharged patients who were not living at home at long-term follow-up. Multivariable analysis showed that not returning home long-term was associated with older age (per year) (odds ratio [OR] 1.06, 95% confidence interval [CI]: 1.04-1.1, P < 0.001), female sex (OR: 3.13, 95% CI: 2-4.89, P < 0.001), preoperative cardiac arrest (OR: 2.21, 95% CI: 1.04-4.72, P = 0.04), and postoperative pulmonary complications (OR: 3.15, 95% CI: (1.99-4.99), P < 001).

CONCLUSION

Two-thirds of patients that survived the perioperative period after rAAA were able to be return to living at home, with a higher majority who follow-up long-term living at home. Older age, female sex, preoperative cardiac arrest, and pulmonary complications were associated with not returning home. A high number of patients did not have long term follow-up after rAAA and represent an area for practice improvement.