Myers, Daniel, MS

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Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTIdentifying Risk Factors for Prolonged HospitalStay and 30 Day Readmission for Elective EVARfor Abdominal Aortic AneurysmsDaniel Myers MSUSF MCOM- LVHN Campus, daniel.myers@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMyers, D. (2016, March 9). Identifying Risk Factors for Prolonged Hospital Stay and 30 Day Readmission for Elective EVAR for AbdominalAortic Aneurysms. Poster presented at: The SELECT Capstone Project in the Kasych Conference Room, Lehigh Valley HealthNetwork, Allentown, PA.   BackgroundWe performed a retrospective analysis of EVAR patient’s electronic patient records at Lehigh Valley Health Network from 2001-2013.  We then examined the postoperative course of these patients for time and complications. Elective repair of an abdominal aortic aneurysm (AAA) before rupture is achievable through both open and endovascular (EVAR) approaches.  Studies that have compared open and EVAR have demonstrated similar long-term mortality and cost, with endovascular therapy demonstrating some short-term advantage in both mortality and cost in the United States.  A cost advantage for EVAR is generally achieved through a shorter hospital length of stay and ICU stay despite high device costs.  Furthermore, prolonged hospital stay is associated with high 30d readmission rates in this population, and 30d readmission is a major risk factor for 1 year mortality in this population.  Studies are yet to define a prolonged hospital stay following EVAR, or examine the causes of prolonged hospital stay after EVAR.  © 2016 Lehigh Valley Health NetworkMaterials and Methods517 elective EVAR procedures were performed. 437 patients (85%) were male, 77 (15%) were female.  78% of patients had an uncomplicated postoperative course with 100% of uncomplicated patients being discharged by postoperative day (POD) 2.  117 (22%) patients had a postoperative length of stay 3 or more days. 100% of these patients experienced a complication from surgery or in their hospital course.  The most common complication to their hospital course was urinary retention in 38 patients, followed by difficult ambulation in 20 patients, and pulmonary complications in 18 patients.  Other causes of prolonged postoperative hospital stay included need for further procedures, cardiac arrhythmias, gastrointestinal complications, fever, and uncontrolled pain.  81 patients (16%) were readmitted within 30 days.Results An uncomplicated postoperative hospital stay following EVAR can be as little as 2 postoperative days.  Postoperative complications following EVAR leading to prolonged hospital stay are common.  Knowledge of these complications may play a factor in reducing 30d readmissions as well as 1 year mortality.  Conclusion To date, studies are yet to define a prolonged hospital stay following EVAR, or examine the causes of prolonged hospital stay after EVAR, a major risk factor for one year mortality. Problem Statement Figure 3: TitleFigure 1: Patients per Number of POD Figure 2: Percent 30d AdmissionLehigh Valley Health Network, Allentown, PAIdentifying Risk Factors for Prolonged Hospital Stay and 30 Day Readmission for Elective EVAR for Abdominal Aortic AneurysmsDaniel Myers» Repeat Vitamin D » Order Vitamin D • Cholecalciferol • 400u/ml liquid • 1,000u chew • 2,000u capsule • 5,000u capsule • Ergocalciferol 50,000u capsule  Endocrine – Diabetes • Risk factors/Symptoms – Family history – Polyuria – Polydipsia – Nocturia/new onset enuresis – Acanthosis Nigricans • If any of the above are positive, consider – HbA1c – Fasting insulin/glucose • Labs within the past 2 years? – Yes » Normal » Abnormal* • HbA1c • Fasting insulin/glucose • Oral glucose tolerance test • Endocrine referral – No » Other • HbA1c • Fasting insulin/glucose • Oral glucose tolerance test » Deferred*  – PCOS • Verbal screen – History of irregular menses > 2 years post menarche? (irregular for 6 months or no menses for 3 months) – Signs of hyperandrogenism? (e.g. hirsutism, male pattern hair, balding or severe acne) – Signs of insulin resistance? (e.g. presence of acanthosis) – Need 3 positive answers to have a positive screen – If positive screen, consider referral to » Adolescent Medicine » Endocrine 

Identifying Risk Factors for Prolonged Hospital Stay and 30 Day Readmission for Elective EVAR for Abdominal Aortic Aneurysms

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Identifying Risk Factors for Prolonged Hospital Stay and 30 Day Readmission for Elective EVAR for Abdominal Aortic Aneurysms

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