Predictive Scoring: Should it Tell Us the Odds?
In their work, Omran et al.1 presented an interesting perspective on pre- and post-operative scoring of patients presenting with ruptured abdominal aortic aneurysm (rAAA), demonstrating that in their study population, multiple existing models could predict mortality. The authors compared the Vascular Surgery Study Group of New England Ruptured Abdominal Aortic Aneurysm (VSGNE rAAA) score, a decision support tool, with the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, two outcome prediction scores, and the SOFA score, an illness severity score.
CONCLUSIONS: This study suggests that EVAR cannot improve survival outcomes compared with OSR if applied solely because a patient is aged ≥80 years. Not only age but also other risk factors and quality of life after surgery need to be further studied.PMID:34670876 | DOI:10.1253/circj.CJ-21-0574
Enhanced recovery after surgery (ERAS) programs provide a streamlined approach for expedient post-operative care of high-volume procedures. Since the implementation of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA), post-operative length of stay (LOS) has continued to decrease to the point where many patients now are discharged the day after the procedure.1-3 Patients that usually meet eligibility criteria for early discharge include those with low preoperative risk and amenable aortic anatomy.
Extensive experience with endovascular aneurysm repair (EVAR) in the elective setting has led to an increase of the use of EVAR in the emergency setting of ruptured abdominal aortic aneurysm (rAAA). Outcomes of EVAR for rAAA have improved over the years, with differences in peri-operative mortality favouring EVAR over open surgery.  Open repair under general anesthesia causes a significant hormonal stress and decreased hemodynamic stability and lower body perfusion.  EVAR performed under local anesthesia may further decrease mortality compared to EVAR under general anesthesia.
To the Editor:
Hospital length of stay (LOS) plays a significant role in healthcare costs and efficiency. Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms has the advantage of a shorter LOS compared with open repair. Based on the National Surgical Quality Improvement Program data, the LOS after EVAR is 2.9 days, with only 19% requiring>4 days of hospitalization. We assessed whether the LOS can be safely shortened with a protocol of monitored anesthesia care (MAC) without Foley catheter placement in EVAR.
CONCLUSIONS: Although the EVAR procedure has been described as a safer and more easily applicable alternative to surgical repair, it is disadvantageous in terms of increasing treatment costs. Anaesthesia preference and incision size with a more minimalist approach can reduce the length of hospital stay and minimize the complications that may occur after the procedure, resulting in decreased costs.PMID:34552644 | PMC:PMC8442085 | DOI:10.5114/kitp.2021.105188