The association between preoperative patient characteristics and both clinical and economic outcomes after abdominal aortic surgery

Objective: To evaluate the association between patient characteristics and both clinical and economic outcomes in patients having abdominal aortic sur gery in Maryland between 1994 and 1996. Design: Retrospective study using an administrative data set. Setting: All Maryland hospitals that performed abdominal aortic surgery fro m 1994 through 1996 (n = 46). Participants: All patients who had abdominal aortic surgery in Maryland fro m 1994 through 1996 (n = 2,987). Interventions: None. Measurements and Main Results: The authors obtained discharge abstracts fro m the Maryland Health Services Cost Review Commission for patients with a p rimary procedure code for abdominal aortic surgery. primary outcome variabl es were in-hospital mortality, hospital length of stay, and intensive care unit (ICU) days. The authors evaluated the following groups of independent variables: demographic characteristics, severity of illness, comorbid disea se, and preoperative admission days. In multivariate analysis, independent predictors of in-hospital mortality were age 61 to 70 years (odds ratio [OR ], 3.1; confidence interval [CI], 1.4 to 6.9), age 71 to 84 years (OR, 7.2; CI, 3.7 to 14.1), age 85 years or older (OR, 9.3; CI, 3.9 to 21.9), ruptur ed aneurysm (OR, 5.3; CI, 3.5 to 8.2), urgent operation (OR, 2.3; CI, 1.1 t o 5.2), emergent operation (OR, 3.0; CI, 1.9 to 4.7), mild liver disease (O R, 4.6; CI, 2.0 to 10.9), and chronic renal disease (OR, 6.9; CI, 3.9 to 12 .1). Hospital admission 1 to 2 days preoperatively was not associated with a difference in in-hospital mortality but was associated with a 31% increas e in hospital days (CI, 23% to 40%) and a 38% increase in ICU days (CI, 19% to 60%). Conclusion:ln patients having aortic surgery, several patient characteristi cs such as mild liver disease and chronic renal failure, were associated wi th increased in-hospital mortality and length of stay. The practice of admi tting patients to the hospital 1 to 2 days before surgery should be reevalu ated because this was not associated with reduced in-hospital mortality but was associated with increased hospital and ICU stay. Copyright (C) 1999 by W.B. Saunders Company.