Predictors of Duration of Postoperative Hospital Stay in Patients Undergoing Advanced Laparoscopic Surgery

Abstract

The expansion of the indications for laparoscopic surgery to include high-risk patient, acute and malignant pathology, and more complex procedures may prolong the hospital stay. Cox multiple stepwise regression analysis model was employed to determine independent predictors of prolonged postoperative hospital stay (more than 3 days) following advanced laparoscopic procedures among 10 variables. Some 130 patients had undergone advanced laparoscopic surgical procedures between November 2000 and August 2003. The median postoperative hospital stay was 3 days (interquartile range 2-5), and 81 patients (62.3%) were discharged within 3 days of surgery. The independent predictors of prolonged postoperative hospital stay were ASA score of 3 or 4 (odds ratio [OR] = 4.610, P = 0.0002) and preoperative hospital stay (OR = 0.151 per day, P = 0.001). Independent predictors of duration of preoperative hospital stay were emergency admission to hospital (OR = 9.516, 95% CI 5.770-13.261, P < 0.0001) and an underlying malignant pathology (OR = 7.948, 95% CI 3.623-12.273, P = 0.0004). Advanced laparoscopic surgery is associated with a short postoperative hospital stay in the majority of patients. Prolongation of the postoperative hospital stay (more than 3 days) may be expected if the patient had been in the hospital with an acute or malignant disease for more than 6 days prior to surgery and in patients with high comorbidity. The duration of surgery has no impact on the duration of the postoperative hospital stay.

Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery

“…These include higher age or BMI, non-Hispanic black or Hispanic race/ethnicity, impaired functional status, insulin-dependent diabetes, chronic steroid or immunosuppressant use , bleeding 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 disorders, chronic kidney disease on dialysis, low albumin level, longer operation time, and concurrent cholecystectomy. Similar results have been noted in other studies; hypoalbuminemia, bleeding diathesis, longer length of surgery, and higher BMI have been found to be predictors of longer hospital stay after LRYGB or advanced laparoscopic surgeries [7,[19][20][21]. Hispanic and black nonHispanic ethnicities have been reported previously as a risk factor for hospital readmission after bariatric surgery [22,23].…”

Factors Associated with Longer Length of Hospital Stay After Primary Elective Ankle Surgery for End-Stage Ankle Arthritis

“…Preoperative patient characteristics that have been implicated include age [17][18][19][20] , sex 17,21,22 , and high ASA grades 19,23 . Our study reflected similar findings, but with subtle variations.…”

Factors associated with prolonged stay after laparoscopic cholecystectomy in elderly patients

“…In the general population, a high American Society of Anesthesiologists (ASA) score and a long preoperative stay are both associated with a longer postoperative stay after laparoscopic cholecystectomy [9], while conversion to open surgery has a minimal impact [10]. For elderly patients, however, there is a paucity of information regarding factors associated with prolonged postoperative hospitalization.…”