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Abstract

Introduction
Day case and short stay surgery pathways are becoming increasingly prevalent. They offer advantages including reducing cost, while improving resource utilisation. Endovascular Aneurysm Repair (EVAR) and Fenestrated EVAR (FEVAR) with their low peri-operative mortality and morbidity could allow a short stay aneurysm repair pathway in select patients.

Aims
This thesis sets out to create and trial a short stay endovascular program to ascertain its safety and applicability.

Methods
A systematic review of the short stay EVAR and FEVAR studies to date was performed. A novel short stay EVAR (SS-EVAR) and FEVAR (SS-FEVAR) criteria was created and retrospectively validated. Qualitative and quantitative methods were used to identify and address the barrier to a safe and effective short stay model of care. The criteria created where tested in a pilot SS-EVAR and SS-FEVAR program using an bundle of care informed by the other studies in this thesis.

Results
Systematic literature review revealed that SS-EVAR programs to date are associated with good patient satisfaction and modest cost savings. The retrospective validation showed the selection criteria allowed up to 60% of EVAR and 65% of FEVAR patients to be safely enrolled with minimal readmissions. Qualitative and Quantitative data collection identified barrier to SS-FEVAR and SS-EVAR that were addressed in a bundle of care and pathway.

Nineteen EVAR patients and Fourteen FEVAR patients were included in a prospective short stay aneurysm repair program, with an average length of stay of 34.8 and 80.7 hours respectively. Both programs were shown to have good eligibility, complication and readmission rates.

Conclusion
SS-EVAR and SS-FEVAR programs can offer a safe and cost-effective pathway, with good acceptability in selected patients. With the ongoing efficiency reforms in the NHS and internationally the ability to offer these treatments at lower cost and equivalent safety is paramount to their ongoing success.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine R Medicine > RA Public aspects of medicine R Medicine > RD Surgery
Departments:	School of Health & Medical Sciences > Cardiovascular and Genomics Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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