Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review

Abstract

BackgroundPatients with prolonged length of hospital stay (LOS) not only increase their risks of nosocomial infections but also deny other patients access to inpatient care. Hepatobiliary (HPB) malignancies have some of highest incidences in East and Southeast Asia and the management of patients undergoing HPB surgeries have yet to be standardized. With improved neurosurgery techniques for intracranial aneurysms and tumors, neurosurgeries (NS) can be expected to increase. Elective surgeries account for far more operations than emergencies surgeries. Thus, with potentially increased numbers of elective HPB and NS, this study seeks to explore perioperative factors associated with prolonged LOS for these patients to improve safety and quality of practice.MethodsA retrospective cross-sectional medical record review study from January 2014 to January 2015 was conducted at a 1250-bed tertiary academic hospital in Singapore. All elective HPB and NS patients over 18 years old were included in the study except day and emergency surgeries, resulting in 150 and 166 patients respectively. Prolonged LOS was defined as above median LOS based on the complexity of the surgical procedure. The predictor variables were preoperative, intraoperative, and postoperative factors. Student’s t-test and stepwise logistic regression analyses were conducted to determine which factors were associated with prolonged LOS.ResultsFactors associated with prolonged LOS for the HPB sample were age and admission after 5 pm but for the NS sample, they were functional status, referral to occupational therapy, and the number of hospital-acquired infections.ConclusionOur findings indicate that preoperative factors had the greatest association with prolonged LOS for HPB and NS elective surgeries even after adjusting for surgical complexity, suggesting that patient safety and quality of care may be improved with better pre-surgery patient preparation and admission practices.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2817-8) contains supplementary material, which is available to authorized users.

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

“…Our study identified several independent baseline associations with prolonged hospitalization. Other studies have similarly revealed that increasing age [ 12 , 17 , 18 , 20 , 22 , 24 , 25 , 28 , 29 , 30 , 33 , 34 , 36 , 38 , 39 , 40 , 50 ], female gender [ 22 , 24 , 26 , 30 , 36 , 39 , 50 ], not being in a relationship, [ 52 ] being a current smoker [ 39 ], level of co-morbidity [ 11 , 12 , 14 , 15 , 16 , 18 , 22 , 26 , 40 , 42 , 44 ], weekend admissions [ 42 ], and the number of prior admissions [ 25 , 32 , 44 ] were associated with prolonged hospitalization.…”

“…Most previous studies of prolonged hospitalization have focused on specific sub-groups of patients such as orthopaedic procedures [ 21 , 24 , 26 , 29 , 30 , 31 , 39 ], cardiovascular disease [ 13 , 15 , 17 , 36 , 37 , 38 ], solid organ transplantation [ 33 , 50 ], or oncological conditions [ 11 , 14 , 18 , 20 , 27 , 28 , 34 , 35 ] ( Supplementary Table S7 ). A limited number of studies have examined the epidemiology of prolonged hospitalization in internal medicine patients [ 23 , 45 , 51 ] but only one of these was multi-centre in nature [ 51 ].…”

“…Several studies have identified factors associated with protracted hospitalization, but many of these have focused on targeted patient populations [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] or involved data collected at a single centre [ 13 , 18 , 19 , 23 , 24 , 28 , 29 , 31 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] Understanding the factors that contribute to prolonged hospitalization in a broader patient cohort may guide the development of interventions that target at risk patients, improve overall care, and reduce resource utilisation.…”

Cerebrospinal Fluid Leak Rate after Vestibular Schwannoma Surgery via Middle Cranial Fossa Approach

“…6,11 Longer LOS in itself can be considered a risk factor for postoperative morbidity, as it has been associated with other complications including thromboembolic events, infection, mood and mental status changes, higher risk for readmission, as well as consumption of hospital resources. 23 Thus, LOS can be used as an indirect marker for postoperative outcome and minimizing factors associated with longer LOS may be beneficial to both patients and caregivers.…”

Neurosurgery in Ukraine: comparison with other countries of the world

“…Забезпеченість нейрохірургічними ліжками в 2019 р. становила 81 на 1 млн населення. Це високий рівень забезпеченості порівняно зі Швецією, Нідерландами, Норвегією та Великою Британією (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), але нижче, ніж у РФ (90), Чехії, Німеччині та Греції (100). Забезпеченість нейрохірургами на 1 млн населення і відношення кількості нейрохірургів до загальної чисельності населення в 2019 р. становило 16,8 та 1:59 502, що відповідає показнику в РФ (16,8 і 1:59 524), значно нижче, ніж в Японії (58,95 і 1:16 962, та вище, ніж у США (15,2 і 1:65 580).…”