Perioperative Factors Affecting Length of Hospital Stay Among Elderly Patients

Gytė Damulevičienė,Jūratė Macijauskienė,Donatas Venskutonis,Vita Lesauskaitė,Kastytis Šmigelskas

doi:10.3390/medicina49060040

Gytė Damulevičienė, Jūratė Macijauskienė + Show 3 more

Open Access

https://doi.org/10.3390/medicina49060040

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Abstract

Timely assessment and prevention of risk factors for the main perioperative complications in elderly patients provide an opportunity to avoid them, decrease mortality, and diminish costs associated with longer hospital stay. The aim of this study was to estimate perioperative factors that could potentially predict the length of stay and to estimate their predictive value using a comprehensive geriatric assessment among elderly patients. The study population comprised 99 surgical patients aged 65 and more. The patients were followed up until discharge. Study data analysis included questionnaires, anthropometric measurements before surgery, assessment and interviews after surgery, and case histories. Univariate and multivariate logistic regression analysis was performed. Malnutrition was detected in 53.5% of the patients. Postoperative cognitive disorder was documented in 18.2% of elderly patients. The mean length of hospital stay was 10.1 days (SD, 9.14). Multivariate logistic regression analysis revealed that the best predictors for longer hospital stay in elderly patients were malnutrition (OR, 4.2; 95% CI, 1.5-11.8; P=0.007) together with postoperative cognitive impairment (OR, 9.2; 95% CI, 1.0-83.3; P=0.048). The total predictive value of the model was 70.5%. . Malnutrition and a postoperative cognitive disorder were independent risk factors for longer hospital stay, while depression, cognitive impairment, functional dependence, and poor physical status were not independently associated with longer hospital stay. A comprehensive geriatric assessment can help assess the risk factors for longer treatment and predict the length of hospital stay, thus enabling the planning of optimal healthcare management of elderly patients.

Highlights

In older age, a decline in functional reserve, impaired reaction to stress, and comorbidities lead to increased postoperative complication and rehospitalization rates, longer duration of postoperative treatment, and higher costs of treatment [1,2,3,4,5,6]
Postoperative cognitive disorder was documented in 18.2% of elderly patients
Multivariate logistic regression analysis revealed that the best predictors for longer hospital stay in elderly patients were malnutrition (OR, 4.2; 95% CI, 1.5–11.8; P=0.007) together with postoperative cognitive impairment (OR, 9.2; 95% CI, 1.0–83.3; P=0.048)

Summary

Introduction

A decline in functional reserve, impaired reaction to stress, and comorbidities lead to increased postoperative complication and rehospitalization rates, longer duration of postoperative treatment, and higher costs of treatment [1,2,3,4,5,6]. The length of hospital stay is a relevant outcome parameter in terms of morbidity and hospital costs [7]. The timely assessment of risk factors for the main perioperative complications, such as delirium, respiratory tract infection, malnutrition, and cardiovascular complications, in elderly patients and timely prevention provide an opportunity to avoid them, decrease mortality, and diminish costs associated with longer hospital stay [4]. The aim of the study was to estimate perioperative factors among elderly patients that potentially predict the length of hospital stay and to estimate their predictive value using a comprehensive geriatric assessment

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