(IP011) Validation of Hospital-free Days as an Outcome Metric After Ruptured Abdominal Aortic Aneurysm Repair

Objectives: Ruptured abdominal aortic aneurysm (rAAA) survivors often experience significant perioperative complications that impact their quality of life. Traditional postoperative outcomes like mortality and readmission rates do not fully capture these effects. This study aims to evaluate Hospital-Free Days (HFDs) as a meaningful, patient-centered metric for assessing post-rAAA repair outcomes.

Methods: We included patients who underwent primary rAAA repair at a tertiary healthcare center and survived the initial hospitalization (2010-2019). Those who had incomplete medical records necessary for calculating HFDs at 90 days post-discharge were excluded. The cohort was compared based on the repair type (open surgical repair [OSR] vs. endovascular repair [EVAR]). The primary outcome was HFDs at 90 days, defined as the number of days alive and out of the hospital or emergency department, starting from the day of surgery (PO-90HFDs) or from the day of discharge (PD-90HFDs). Multivariate ordinal logistic regression model evaluated factors associated with the PO-90HFDs and PD-90HFDs.

Results: Among the 217 patients who underwent rAAA repair and survived to discharge, 197 patients (90.8%) had available medical records to calculate HFDs and were included (mean age 72.3 years, standard deviation [SD]: 10.0); 76.1% were male, and 45.2% underwent OSR). The median PO-HFDs was significantly higher for patients undergoing EVAR compared to the OSR group (82 days, interquartile range [IQR]: 72.5, 85] vs. 76 [63, 81], p< 0.001), while the median PD-HFDs was similar between EVAR and OSR groups (90 days [IQR: 83.5, 90] vs. 90 [81, 90], p=0.78). The median index hospitalization length of stay (LOS) was significantly higher for patients undergoing OSR compared to the EVAR group (10 days, [IQR]: 8, 17] vs. 6 [3.5, 10], p< 0.001). In multivariate analysis, OSR (aOR 0.50, 95% CI 0.29–0.86, p=0.01), prolonged ICU LOS (aOR 0.84, 95% CI 0.80–0.89, p< 0.001), and a history of coronary artery disease (aOR 0.56, 95% CI 0.33–0.94, p=0.30) were identified as significant factors associated with fewer PO-HFDs (Fig 1). However, only prolonged ICU LOS (aOR 0.92, 95% CI 0.87–0.97, p=0.002) was significantly associated with fewer PD-HFDs, while OSR (aOR 1.55, 95% CI 0.83–2.90, p=0.17) did not show a significant association (Fig 2).

Conclusions: HFDs provide a valid and patient-centered outcome metric. Our results suggest that long-term recovery is more influenced by clinical severity than by the repair type. While PO-HFDs are worse for OSR compared to EVAR, this difference is primarily driven by prolonged hospitalization. Future research should further explore patient-reported outcomes.