Ani Bagdasarian, MSN, MPH, RN, AGACNP-BC

All Publications

• Leveraging the Vascular Quality Initiative to Reduce Length of Stay following Elective Carotid Endarterectomy and Endovascular Aortic Aneurysm Repair. Journal of vascular surgery Dossabhoy, S. S., Lahiji-Neary, T., Morta, J., Miklosey, L., Flores, T., King, C., Moreno, C. A., Fallorina, R., Bagdasarian, A., Arya, S., Stern, J. R., Lee, J. T., Dalman, R. L. 2025

  Abstract

  Length of stay (LOS) is a key quality metric for the Society for Vascular Surgery's Vascular Quality Initiative (VQI). In 2021, our hospital was an outlier for 'prolonged LOS' after carotid endarterectomy (CEA >1 day, 67% vs target 21%) and endovascular aortic aneurysm repair (EVAR >2 days, 36% vs target 22%). In response, we launched a quality improvement (QI) initiative to reduce LOS following elective CEA and EVAR.We completed a retrospective review of all CEA and EVAR cases (1/2021 to 3/2022) using data obtained from VQI. During the intervention phase (4/2022 to 7/2023), a multidisciplinary team defined the problem state, refined workflows, used Plan-Do-Study-Act method to address key drivers, and maintained a prospective database of patients and LOS outcomes. Preoperative interventions educated patient stakeholders (e.g., nurses, case managers, trainees) on LOS benchmarks, communicated expected discharge date and time to patients/families, and screened all patients for high-risk discharge, leading to prolonged LOS. After surgery, recovery protocols were standardized, including Foley catheter removal midnight POD0 and physical therapy evaluation morning POD1. Primary outcomes, rates of prolonged LOS and mean LOS (days, hours), and secondary outcomes (discharge within 1 day, readmission, mortality) were compared pre and post-intervention.Overall, 120 patients were included (48 CEA, 72 EVAR) with 52 (22 CEA, 31 EVAR) pre-intervention and 67 (26 CEA, 41 EVAR) post-intervention. Over the intervention, rate of prolonged LOS significantly decreased from 50% to 15% for CEA (P=.01) and 26% to 7% for EVAR (P=.03). While mean LOS decreased for CEA from 2.2 ± 3.1 days to 1.2 ± 0.5 days (52.7 ± 75.7 hours to 27.7 ± 12.0 hours) and for EVAR from 2.3 ± 1.8 days to 1.5 ± 1.5 days (55.1 ± 43.2 hours to 36.9 ± 35.5 hours). Patients discharged within 1 day from surgery significantly increased from 50% to 85% for CEA and 45% to 76% for EVAR (both P=.01). Balancing measures of 30-day readmission and mortality did not significantly increase following our intervention with three readmissions overall and no deaths in either cohort. Our Fall 2023 VQI Regional Report confirmed these findings with reduced LOS for CEA and EVAR below regional and national targets.VQI benchmarking identifies system-wide, surgeon-specific QI opportunities. Through engaging multidisciplinary teams and implementing patient-centric interventions across the care continuum, we successfully reduced LOS for CEA and EVAR below VQI targets.

  View details for DOI 10.1016/j.jvs.2025.01.232

  View details for PubMedID 39971145

• Implementation of a Preoperative Frailty Screening and Optimization Pathway for Vascular Surgery Patients is Associated with Decreased 30-Day Readmission. Journal of vascular surgery Dossabhoy, S. S., Manuel, S. R., Yawary, F., Lahiji-Neary, T., Cheng, N., Cianfichi, L., Bagdasarian, A., George, E. L., Marwell, J. G., Lee, J. T., Dalman, R. L., Schmiesing, C., Arya, S. 2024

  Abstract

  Frailty is characterized by reduced physiologic reserve and vulnerability to adverse events in the presence of a stressor such as surgery. We prospectively implemented a preoperative frailty screening and optimization pathway for vascular surgery patients and assessed its impact on postoperative outcomes.As part of an ongoing quality improvement initiative, surgical frailty was assessed prospectively in all patients undergoing inpatient surgery using the Risk Analysis Index (RAI). Baseline data were collected from May to July 2022. Frail patients (RAI score ≥ 37) were referred to an anesthesia optimization clinic, nutrition consultation, and case management evaluation in the intervention phase (August 2022 to July 2023). Primary outcomes were postoperative hospital length of stay, 30-day readmission, and 30-day mortality. Secondary outcomes included ICU admission, ICU length of stay, discharge disposition, and non-home discharge. Two-way analyses compared frail vs non-frail patients and pre- vs post-intervention groups using Student t-test or Wilcoxon rank sum test for continuous variables and chi-squared or Fisher's exact test for categorical outcomes.Of all patients scheduled for elective inpatient vascular surgery procedures at a single institution (N=225), 216 completed frailty screening [mean age 72 years, 68.5% male, 54.6% white, mean RAI 28.9, 18.5% frail]. Of these, 15 had surgeries cancelled, and 201 ultimately underwent surgery with 36 (17.9%) identified as frail. Overall, frail patients had significantly longer ICU (median [IQR] 4.0 [2.5, 13.5] vs 2.0 [1, 4] days, P=.001) and hospital length of stay (2.45 [1.51, 5.67] vs 1.23 [1.0, 2.10] days, P=.001), higher non-home discharge (30.6% vs 4.2%, P<.0001), and higher 30-day readmission (22.2% vs 6.7%, P=.009) compared to non-frail patients. Comparing pre- and post-intervention groups, 30-day readmission for the overall cohort declined significantly (22.2% to 7.5%, P=.03). Amongst frail patients, there was a trend to reduced hospital length of stay (4.73 to 2.14 days), non-home discharge (57.1% vs 24.1%), and 30-day readmission (42.9% to 17.2%); however, these did not reach statistical significance. Overall, 30-day mortality was 1.5% with all 3 deaths (2 frail, 1 non-frail) occurring post-intervention (0% pre vs 1.7% post, P=1.0).Successful implementation of a preoperative frailty screening and optimization pathway for patients undergoing elective vascular surgery led to a significant decrease in overall 30-day readmission and a trend toward reduced hospital length of stay, non-home discharge, and 30-day readmission for frail patients. Further expansion to all surgical clinics has the potential to improve quality metrics for the healthcare system.

  View details for DOI 10.1016/j.jvs.2024.11.018

  View details for PubMedID 39581332

• Effectiveness and Safety of an Independently Run Nurse Practitioner Outpatient Cardioversion Program (2009 to 2014) AMERICAN JOURNAL OF CARDIOLOGY Norton, L., Tsiperfal, A., Cook, K., Bagdasarian, A., Varady, J., Shah, M., Wang, P. 2016; 118 (12): 1842-1846

  Abstract

  Sustained growth in the arrhythmia population at Stanford Health Care led to an independent nurse practitioner-run outpatient direct current cardioversion (DCCV) program in 2012. DCCVs performed by a medical doctor, a nurse practitioner under supervision, or nurse practitioners from 2009 to 2014 were compared for safety and efficacy. A retrospective review of the electronic medical records system (Epic) was performed on biodemographic data, cardiovascular risk factors, medication history, procedural data, and DCCV outcomes. A total of 869 DCCVs were performed on 557 outpatients. Subjects were largely men with an average age of 65 years; 1/3 were obese; most had atrial fibrillation; and majority of subjects were on warfarin. The success rate of the DCCVs was 93.4% (812 of 869) with no differences among the groups. There were no short-term complications: stroke, myocardial infarction, or death. The length of stay was shortest in the NP group compared to the other groups (p <0.001). In conclusion, the success rate of DCCV in all groups was extremely high, and there were no complications in any of the DCCV groups.

  View details for DOI 10.1016/j.amjcard.2016.08.074

  View details for Web of Science ID 000389868400011

  View details for PubMedID 27771002