(IP153) The Predictors of Prolonged Length of Stay Following Elective Aortobifemoral Bypass for Aortoiliac Occlusive Disease

Objectives: Elective aortobifemoral bypass (ABFB) is the traditional approach for managing aortoiliac occlusive disease (AIOD). Despite advancements in surgical care, prolonged length of stay (PLOS) remains a significant concern and impacts outcomes and costs. This study aimed to identify predictors of PLOS following elective ABFB using national data.

Methods: Elective ABFB cases for AIOD from the Vascular Quality Initiative (VQI) database (2009 to 2023) were queried. PLOS was defined as longer than 7 days stay following surgery, < 7 days was considered standard length of stay (SLOS). The primary outcome was identifying predictors of PLOS. Secondary outcomes included associations of PLOS with postoperative complications, one- and three-year mortality, one-year major amputation (MA), and one-year amputation-free survival.

Results: Of the 6,911 cases, 2,380 (34.4%) patients had PLOS. Logistic regression showed PLOS was associated with age, non-white race, preoperative non-ambulatory status, hypertension, COPD, anticoagulation use, presentation with CLTI, procedure time, completion angiography, RBC transfusion, and postoperative vasopressor use (Figure I). The model had an area under the curve of 0.70, with a Hosmer–Lemeshow chi-squared statistic of 13.76 (P=.088), indicating good fit. Postoperative complications associated with PLOS included postoperative MI (aOR=2.45 [95%CI, 1.77-3.40]; P=.001), respiratory complications (aOR=4.88 [95%CI, 3.83-6.22]; P=.001), CHF (aOR=4.53 [95%CI, 3.22-6.38]; P=.001), and surgical site infection (aOR=6.52 [95%CI, 4.61-9.22]; P=.001). Additionally, PLOS was associated with increased hazards of one-year combined MA and/or death (aHR=1.40 [95%CI, 1.08-1.82]; P=.010) and three-year death (aHR=1.44 [95%CI, 1.16-1.79]; P=.001) (Figure II).

Conclusions: PLOS following elective ABFB is associated with non-modifiable risk factors, including advanced age, non-white race, and various preoperative and intraoperative variables. Understandably, patients with postoperative complications face higher risks of PLOS and adverse long-term outcomes. These findings can help guide surgical approach and help plan resource utilization for high risk patients who cannot be treated with less invasive means.