Monitored Anesthesia Care Without Foley Placement Decreases Hospital Length of Stay in Elective Endovascular Abdominal Aortic Aneurysm Repair

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. A retrospective analysis of EVARs at a large tertiary hospital from January 2018 to December 2020 was conducted. We analyzed the subset of patients who had undergone elective EVAR with MAC and local analgesia without Foley catheter insertion. Data were collected from the electronic medical records, with a focus on LOS, interval to ambulation (in days), postoperative urinary retention (POUR), and major complications. Statistical analysis was performed using the Mann-Whitney U test. Of 107 patients who had undergone EVAR, 93 were performed electively and 46 were performed electively with MAC and local anesthesia. Of the 46 patients, 35 (76.1%) were discharged on postoperative day 1 and 42 (91.3%) ambulated on postoperative day 1. Of the 107 patients, 37 had had no perioperative Foley catheter placed and 9 patients had had an intraoperative Foley catheter removed in the operating room. Only eight patients (17.4%) had experienced POUR; five patients had required only one straight catheterization and two were discharged with a Foley catheter in place. POUR was not related to case duration (114.5 minutes without POUR vs 129.1 minutes with POUR; P = .368) or the number of pieces implanted (2.87 pieces without POUR vs 2.5 pieces with POUR; P = .921). No patient had required intubation. The average LOS was 2.0 days. Three patients had developed postoperative arrhythmia requiring intensive care unit monitoring, one patient had a pseudoaneurysm requiring thrombin injection, and one patient had had unplanned renal artery coverage requiring exploratory laparotomy for hepatic artery to renal artery bypass. These data suggest that the LOS after EVAR can be safely shortened using a standardized protocol of MAC and local analgesia without routine Foley catheter placement. Further investigation is warranted to determine the feasibility of performing elective EVAR in a nonhospital setting.