Longer Postoperative Length Of Stay Research Articles

Is mechanical bowel preparation in laparoscopic radical prostatectomy beneficial? An analysis of a Japanese national database

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Recently, the ineffectiveness of bowel mechanical preparation prior to colorectal surgery was focused on. Although its effectiveness was widely accepted in laparoscopic prostatectomy, the data were limited. This retrospective multicentre study compared laparoscopic prostatectomy cases with and without bowel preparation and did not demonstrate the preparation's preferable effect in operation time and complication incidence, which suggested justification of the omission of bowel preparation. To evaluate the effect of mechanical bowel preparation (MBP) prior to laparoscopic radical prostatectomy on peri-operative outcomes. Patients undergoing laparoscopic radical prostatectomy for T1-T2 tumours between 2008 and 2010 were identified in the Japanese Diagnosis Procedure Combination database. Patients were classified into a preoperative MBP group and a non-MBP group. The effects of MBP were evaluated by multivariate regression analysis of overall complication rate, operation time, postoperative length of stay (PLOS) and total costs with generalized estimating equations adjustment involving age, body mass index, Charlson score, hospital academic status and hospital volume. Comparing the 154 non-MBP and 580 MBP patients, overall complication rate, operation time, PLOS and total costs were 6.5% vs 6.9% (P = 0.860), 222 vs 250 min (P = 0.001), 11 vs 10 days (P < 0.001) and 18,941 vs 19,015 US dollars (P = 0.032), respectively. In the multivariate analyses, no significant differences were observed for the four outcomes (P = 0.961, 0.194, 0.383 and 0.993, respectively). Complications were more frequently observed in older patients, and operation time tended to be longer in patients with higher body mass index and in hospitals with lower volumes. Longer PLOS and higher total costs were associated with older age, higher Charlson score and lower hospital volume. We could not find any superiority of MBP on overall complications, operation time, PLOS and total costs in laparoscopic radical prostatectomy. The results support that MBP can be omitted prior to laparoscopic radical prostatectomy for T1-T2 prostate cancer.

Relationship between Resource Utilization and Length of Stay Following Tetralogy of Fallot Repair

The relationship between resource utilization and postoperative length of stay (PLOS) following congenital heart disease surgery is unknown. We performed a retrospective cohort study using data from the Pediatric Health Information Systems database. We included subjects 1 month to 1 year of age with a PLOS of ≤ 1 month following elective, complete repair of tetralogy of Fallot (TOF) during 2004-2008 at children's hospitals that performed ≥ 10 such surgeries during the study period. We constructed three generalized linear models to assess the relationships of total costs, laboratory costs, and imaging costs during the first three postoperative days with overall PLOS. Race/ethnicity, insurance type, sex, and presence of a genetic syndrome (by ICD-9 codes) were included in the models as fixed effects; hospital of surgery was included as a random effect. For 1161 eligible surgical encounters at 36 children's hospitals, mean PLOS was 7.1 days (median = 6 days). Mean total, laboratory, and imaging costs for the first three postoperative days were $26,455, $2941, and $813, respectively. Most subjects were male (58.9%), did not have a genetic syndrome (88.3%), were non-Hispanic white (58.3%), and had either public or private insurance (41.0% and 39.1%, respectively). An estimated increase in total costs of $4600 or laboratory costs of $700 in the first three postoperative days was associated with a 1-day increase in PLOS. Imaging costs were not associated with PLOS. Increased resource utilization is not associated with a shorter PLOS following elective TOF repair, and it may be associated with longer PLOS.

Preoperative factors prolonging the length of stay in elective colorectal surgery

In elective colorectal resections, the patient's preoperative social situation may play a significant role in delaying their discharge from hospital. The aim of this study was to identify which preoperative factors are associated with non-medical reasons for a delay in discharge and prolonged length of stay (LOS) in hospital after elective colorectal resections. A retrospective review of prospectively collected data was performed on all the elective colorectal resections done at Westmead Hospital for over 2 years between 2007 and 2008. LOS, whether there was a delay in discharge because of non-medical reasons, preoperative factors such as sex, age, marital status, country of birth, use of an interpreter, any children, type of residence, use of community services, American Society of Anaesthesiology (ASA) score, and whether the patient lives on their own, is a sole carer or requires help with activities of daily living were recorded. Overall median age was 66 years (58–75 years). Median post-operative LOS for patients not delayed in discharge was 8 days and 15 days for patients with an identifiable non-medical reason for delay (P < 0.0001). Preoperative factors significantly associated with a delay included advanced age (odds ratio (OR): 10.5; 95% confidence interval (CI): 3.0–37.7; P < 0.0001), being widowed (OR: 3.5; 95% CI: 1.2–10.2; P = 0.02) and living in a retirement village (OR 15.4; 95% CI: 1.6–150.3; P = 0.019). Higher ASA scores strongly correlated with longer LOS. This study confirms that preoperative factors are important in contributing to non-medical delays in discharge and longer post-operative LOS after elective colorectal resections.

Length of stay after infant heart surgery is related to cognitive outcome at age 8 years

Objective To test the hypothesis that postoperative length of stay (LOS) after infant heart surgery might be an easily measured surrogate marker for various events that culminate in later adverse cognitive outcome.Methods Among 160 eligible patients with D-transposition of the great arteries undergoing reparative surgery in infancy, 155 (97%) were reevaluated at age 8 years with IQ and achievement testing. We explored whether LOS quartiles were associated with these outcomes when adjusting for perioperative and sociodemographic variables.Results Longer cardiac intensive care unit (CICU) LOS quartiles were associated at age 8 years with lower full-scale IQ (P=.02), lower verbal IQ (P=.02), and with tendencies toward lower performance IQ (P=.08) and math achievement (P=.08) in adjusted models. Compared with patients in the first quartile of CICU LOS, those in the fourth quartile had mean scores for full-scale IQ that were lower by 7.2 points (P=.01); verbal IQ, 7.3 points (P=.02); performance IQ, 5.8 points (P=.05); and math achievement, 6.0 points (P=.07). Analyses on hospital LOS quartile were similar.Conclusions Longer postoperative LOS is associated with worse later cognitive function, even when adjusted for perioperative events, perfusion times, and sociodemographic variables. Further research is necessary to determine the mechanisms underlying this relation.

Does Gender Influence Resource Utilization in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery?

Objective: The purpose of the present study was to examine if gender influences duration of tracheal intubation, blood transfusion needs, intensive care unit length of stay (ICULOS), postoperative length of stay (PLOS), and total length of stay (LOS) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Design: Retrospective study of consecutive patients undergoing OPCAB surgery. Setting: University teaching hospital. Tertiary care referral center for cardiac surgery. Participants: Three hundred seventy-two consecutive male and female patients undergoing OPCAB surgery. There were 110 women and 262 men. Interventions: None. Measurements and Main Results: Gender, duration of tracheal intubation, units of blood transfused, ICULOS, PLOS, and LOS were collected from the records of patients undergoing OPCAB surgery at the authors’ institution over a period of 16 months. There were a total of 372 patients: 110 women and 262 men. Median intubation time was 4.5 hours for women and 4.0 hours for men ( p = 0.749); 59.1% of women received red blood cells versus 31.3% of men ( p < 0.001). Median ICU LOS was 1 day for women and 1 day for men ( p = 0.597) Median PLOS was 4 days for women and 4 days for men. Median LOS was 8 days for women and 6 days for men ( p = 0.001). Conclusion: Female sex was a predictor of increased blood transfusion and longer PLOS and LOS in patients undergoing OPCAB surgery. The study implies that female sex does not predict increased duration of tracheal intubation and mechanical ventilation and ICULOS in this group of patients. Females undergoing OPCAB surgery require increased resource utilization as measured by increases in blood transfusion, PLOS, and LOS.