Number Of Preoperative Medications Research Articles

Comparative study between trabeculectomy with collagen implant versus trabeculectomy with mitomycin C in patients requiring glaucoma surgery at a tertiary care hospital in Rajasthan

Glaucoma is a chronic multifactorial degenerative optic neuropathy and is the second leading cause of irreversible blindness worldwide. Aim of this study was to study trabeculectomy with collagen implant versus trabeculectomy with mitomycin C in patients requiring glaucoma surgery50 eyes of 44 patients were assigned randomly to undergo trabeculectomy either with collagen implant (study group) or with MMC (mitomycin C)(control group). Preoperative data included age, gender, IOP (intraocular pressure) and number of preoperative medications. Postoperatively IOP, number of glaucoma medications and postoperative complications if any were recorded on follow up at seven days, one month and three months. Proportion was compared using chi square test while mean using student t test.Baseline characteristics were matched. The intervention arm had lower IOP post operatively at 3 months (11.84±4.21 vs 17.72±5.93, p = 0.002) but not at day 7 (17.14±9.88 vs 21.37±11.07, p=0.12), 1 month (16.77±11.54 vs 22.91±9.62 p = 0.05); lesser need of anti-glaucoma medication (0.48±0.77 vs 1.95±1.26 p = 0.0001); more complete treatment success (15 vs 7), lower treatment failure (1 vs 4), less Postoperative complications were seen in cases than controls, flat AC(12%vs16%), Hyphema (4% vs 8%); However hypotony were comparable(12%). This study supports superiority of collagen implant with trabeculectomy as opposed to trabeculectomy with mitomycin C in terms of better clinical outcome and reduced post operative antiglaucoma medications.

Abstract P168: Predictors Of Htn Remission Post-bariatric Surgery: A Contemporary Analysis

Introduction: The effect of bariatric surgery on improvement and remission of hypertension (HTN) is well documented. However, the factors that influence HTN remission in this population are poorly understood and have not been investigated in over a decade. We aim to describe predictors of HTN remission post-bariatric surgery in a contemporary patient population. Methods: All patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass from January 2014 to December 2018 at an urban academic institution were included in the analysis. Blood pressure (BP) was recorded pre-operatively, 6-month post operation, and 12-month post operation. HTN was defined as BP ≥ 140/90 or patients on anti-hypertensive medications. Remission was defined as BP < 140/90 off all blood pressure medications. Baseline characteristics of patients with and without HTN remission were described. Logistic regression analysis was performed to assess indicators of HTN remission. A p-value of 0.05 was used for all statistical analyses. Results: Among 844 patients who underwent bariatric surgery, 497 (58.9%) patients had HTN. Among HTN patients 167 (33.6%) had remission at 6 months and 126 (25.4%) had remission at 12 months. The major predictor of HTN remission on multivariate analysis was number of pre-operative medications at 6 months (OR 2.5, 95% CI 2.03 to 3.29) and 12 months (OR 2.6, 95% CI 1.99 to 3.56). Major predictors on univariate analysis at 12 months were CVA (OR 4.3, 95% CI 1.40 to 12.47) and HLD (OR 1.76, 95% CI 1.27 to 2.45). Conclusion: Number of pre-operative medications is a top predictor of HTN remission. HLD and history of stroke may be present in patients who are less likely to have HTN remission.

THE OUTCOMES OF TRABECULECTOMY WITH ADJUNCTIVE SUBCONJUNCTIVAL MITOMYCIN C AMONG PATIENTS REQUIRING GLAUCOMA SURGERY AT A TERTIARY CARE HOSPITAL IN RAJASTHAN, INDIA

Introduction: Glaucoma is a chronic multifactorial degenerative optic neuropathy and is the second leading cause of irreversible blindness worldwide. Material And Methods: 50 eyes of 50 patients of diagnosed glaucoma not controlled by maximal medical therapy underwent trabeculectomy adjuncted with subconjunctival Mitomycin C. Preoperative data included age, gender, IOP(intraocular pressure) and number of preoperative medications. Postoperatively IOP, number of glaucoma medications and postoperative complications if any were recorded on follow up at seven days, one month and three months. Results: Baseline characteristics were matched. Preoperative IOP was 33.23±8.41 mm of hg which drastically dropped to 14.67±5.78 mm of hg 3 months postoperatively. The need for postoperative antiglaucoma medications also dropped from 3.92±1.14 medications used preoperatively to 1.14±1.26 postoperatively. Success rate was 50% out of which 46% had complete success while 44% had qualied success. Postoperative complications seen were hypotony(14%), Flat AC(12%), Hyphema (6%), Flat Ac with raised IOP(2%), and Cystoid macular edema (2%). Discussion: In conclusion, this study shows that trabeculectomy with adjunctive MMC provides good patient outcome in the form of treatment success in 90% and reduced postoperative antiglaucoma medications in patients and is a good alternative to trabeculectomy alone.

Factors Associated with Refractory Nasal Congestion Following Adenoidectomy.

The objective of this study was to better characterize factors associated with refractory rhinitis in pediatric patients who underwent adenoidectomy compared to those who had symptom resolution. The authors conducted a case series of patients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018. Patients who underwent tonsillectomy and adenoidectomy or who underwent adenoidectomy for indications other than rhinitis were excluded. Patients who had refractory rhinitis symptoms postoperatively were compared to those who had resolution of their symptoms using Chi-square analysis and t-tests. One hundred three patients who had refractory symptoms following adenoidectomy were compared to 139 patients who had resolution of symptoms. Patients who had refractory symptoms had significantly higher proportion of use (89.3%, P = .0011) and higher mean number of preoperative (1.50, P = .0226) and postoperative (1.10, P < .0001) medications, including nasal saline, intranasal steroids, antihistamines, and/or antibiotics. They were more likely to receive postoperative allergy evaluations (50%, P = .0068) and repeat surgery (30.1%, P < .0001), and had a higher proportion of reported history of allergies (24.3%, P = .0089). Use and number of preoperative medications, reported history of allergies, and postoperative allergy evaluation were significantly higher in patients with refractory chronic rhinitis following adenoidectomy. This study identified differences in patients who developed refractory symptoms that may help clinical decision making for surgical management.

Short stay total joint arthroplasty program: patient factors predicting readmission

The aim of this study was to evaluate the effectiveness of our short stay arthroplasty program as measured by 30-day readmission rate and the rate of transfer to inpatient care. Risk factors for readmission/transfer were also evaluated and contrasted with current patient screening criteria. We retrospectively reviewed 297 charts for all primary total joint arthroplasties completed in the short stay program during an 18-month period. Data included readmission and patient characteristics such as age, sex, comorbidities, the American Society of Anesthesiologists (ASA) physical classification grade, body mass index (BMI) and the number of preoperative medications. The 30-day readmission rate was 2.6% (n = 8). With the inclusion of patients transferred to the inpatient hospital, the overall failure rate of our short stay program was 6.7% (n = 20). Multivariable modelling controlling for age, BMI and ASA suggested that those with an in-hospital complication were 11.4 times more likely to be readmitted or transferred to inpatient care (p < 0.001) with a trend for patients who were taking more medications (p = 0.09). The current readmission rate from this program is comparable to previously published data in the arthroplasty literature. However, several patients required transfer to inpatient care, which significantly impacted the effectiveness of the short stay program. Risk factors for readmission/transfer are not completely accounted for by current presurgical screening criteria. Further evaluation of the Blaylock Risk Assessment Screening Score is required to determine its value for predicting hospital readmission.

Socio-demographic factors impact time to discharge following total knee arthroplasty.

AIMTo determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).METHODSThe study included primary TKA’s performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.RESULTSEight hundred and six consecutive primary SSP TKA’s were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer (P < 0.001)], female gender [4.3 h longer (P = 0.012)], age [3.5 h longer per ten-year increase in age (P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported (P = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time (P = 0.004)] and Black or African American patients [6.1 h longer (P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter (P = 0.011)] and TKA’s performed during holiday weeks [9.4 h shorter (P = 0.011)]. Non-significant factors included: BMI, median income, patient’s living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.CONCLUSIONThe cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.

Morbidity and Risk Factors of Laparoscopic-Assisted Ileostomies in Children With Ulcerative Colitis.

Laparoscopic-assisted ileostomy (LAI) represents a cornerstone for the staged approach to ulcerative colitis (UC). The aim is to determine stoma morbidity in a series of pediatric patients and possibly identify specific risk factors. All of the patients who underwent LAI for UC between January 2008 and December 2014 were included. The following data were collected: patient demographics, preoperative medical treatment, body mass index (BMI) at surgery, Pediatric UC Index (PUCAI), and stoma-related complications. In this series of patients, a staged approach has been adopted (subtotal colectomy + ileostomy; restorative proctocolectomy with J-pouch ileo-rectal anastomosis + ileostomy; ileostomy closure). Seventy-two LAIs were fashioned in 37 pediatric patients with UC. Median age at surgery was 12 years (range 5-14.8 years). Boy to girl ratio was 0.85:1. Mortality was zero. Complications occurred after 8 procedures after a median of 31 days postoperatively (range 8-60 days). Those were significantly more frequent in the case of BMI-z score >-0.51 (deleted in revised manuscript, ie, relatively overweight patients) and in the case of preoperative azathioprine administration. Pediatric UC Index score, sex, number of preoperative medications, and other preoperative parameters did not correlate with the incidence of complications. Our study suggests to keep a prudent behavior in the case of patients with a BMI-z score >-0.51 and received preoperative azathioprine administration. Parents should be adequately acknowledged on this regard.

Stratification of phaco-trabectome surgery results using a glaucoma severity index

The outcomes of phacoemulsification combined with trabectome surgery was analyzed using a glaucoma severity index based on preoperative intraocular pressure (IOP), number of preoperative medications, and visual field damage. Despite a less absolute indication to lower IOP, a substantial pressure reduction was seen in patients with more advanced glaucoma.

Impact of a Glaucoma Severity Index on Results of Trabectome Surgery: Larger Pressure Reduction in More Severe Glaucoma.

PurposeTo stratify outcomes of trabectome-mediated ab interno trabeculectomy (AIT) by glaucoma severity using a simple and clinically useful glaucoma index. Based on prior data of trabectome after failed trabeculectomy, we hypothesized that more severe glaucoma might have a relatively more reduced facility compared to mild glaucoma and respond with a larger IOP reduction to trabecular meshwork ablation.MethodsPatients with primary open angle glaucoma who had undergone AIT without any other same session surgery and without any second eye surgery during the following 12 months were analyzed. Eyes of patients that had less than 12 months follow up or were diagnosed with neovascular glaucoma were excluded. A glaucoma index (GI) was created to capture glaucoma severity based on visual field, number of preoperative medications, and preoperative IOP. Visual field (VF) was separated into 3 categories: mild, moderate, and advanced (assigned 1, 2, and 3 points, respectively). Preoperative number of medications (meds) was divided into 4 categories: ≤1, 2, 3 or ≥4, and assigned with a value of 1 to 4. Baseline IOP (IOP) was divided into 3 categories: <20 mmHg, 20–29 mmHg, and greater than 30 mmHg and assigned with 1 to 3 points. GI was defined as IOP × meds × VF and separated into 4 groups: <6 (Group 1), 6–12 (Group 2), >12–18 (Group 3) and >18 (Group 4). Linear regression was used to determine if there was an association between GI group and IOP reduction after one year or age, gender, race, diagnosis, cup to disc (C/D) ratio, and Shaffer grade.ResultsOut of 1340 patients, 843 were included in the analysis. The GI group distribution was GI1 = 164, GI2 = 202, GI3 = 260, and GI4 = 216. Mean IOP reduction after one year was 4.0±5.4, 6.4±5.8, 9.0±7.6, 12.0±8.0 mmHg for GI groups 1 to 4, respectively. Linear regression showed that IOP reduction was associated with GI group after adjusting for age, gender, race, diagnosis, cup to disc ratio, and Shaffer grade. Each GI group increase of 1 was associated with incremental IOP reductions of 2.95±0.29 mmHg. Success rate at 12 months was 90%, 77%, 77%, and 71% for GI groups 1 to 4. The log-rank test suggested significant differences between GI groups.ConclusionA simple glaucoma index, GI, was created to capture glaucoma severity and a relative resistance to treatment. A higher GI was associated with a larger IOP reduction in trabectome surgery. This indicates that there is a role for AIT beyond mild glaucoma and ocular hypertension.

Clinical results of Trabectome surgery for open-angle glaucoma.

BackgroundThe purpose of this study was to determine outcomes when using Trabectome surgery and to evaluate factors associated with its effects in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG).MethodsThis was a prospective, non-randomized, observational, comparative cohort study in which Trabectome surgery was used alone in patients with POAG or EXG. Trabectome surgery was considered to have failed when at least one of the following three criteria was fulfilled: intraocular pressure (IOP) ≥21 mmHg and a <20% reduction below the baseline IOP on two consecutive follow-up visits 3 months or more after surgery; need for additional glaucoma surgery; and an increase in number of medications compared with baseline.ResultsThe subjects were 32 males (34 eyes) and 46 females (48 eyes). POAG was observed in 43 eyes and EXG in 39 eyes. IOP after Trabectome surgery decreased significantly from 22.3±6.8 mmHg at baseline to 14.0±3.9 mmHg (23.0% reduction) at month 24 in all cases (P<0.0000). The success rate at 2 years was 51.2% for all cases (POAG, 50.9%; EXG, 49.2%). There was no significant difference in success rate between POAG and EXG (P=0.91). Preoperative IOP (P=0.033) and number of medications (P=0.041) were significant factors for surgical success/failure in multivariate logistic regression. No serious complications were observed.ConclusionTrabectome surgery achieved favorable IOP control and was equally effective in patients with POAG and those with EXG. Its effects were influenced by preoperative IOP and number of preoperative medications.

Using the Early Postoperative Intraocular Pressure to Predict Pressure Control After a Trabeculectomy

The goal of this study was to identify the early postoperative intraocular pressure (IOP) that predicts low pressure control after a trabeculectomy with mitomycin C. This study retrospectively analyzed the medical records of the initial trabeculectomy with mitomycin C in patients with primary open-angle glaucoma. We established 2 target postoperative IOPs, ≤11 and ≤15 mm Hg. The preoperative and early postoperative factors contributing to the success and failure of postoperative IOP control were studied by multiple regression analyses. These factors included the sex and age of patients, record of cataract surgery, number of preoperative medications, preoperative IOP, IOP recorded 2 weeks after surgery, laser suture lysis after surgery, and the presence of a shallow anterior chamber and choroidal detachment during the first month after surgery. The optimal IOP levels 2 weeks after surgery for long-term IOP control were examined using the Kaplan-Meier survival analyses. Sixty-six patients (66 eyes) with open-angle glaucoma participated in the study. The age and IOP 2 weeks after surgery were selected as the confounding factors affecting the probability of successfully satisfying both target IOPs;≤11 and≤15 mmHg postoperatively. An IOP under 8 mm Hg at 2 weeks after surgery was found to be associated with maintaining the postoperative IOP at either ≤11 and ≤15 mm Hg for an extended period. An IOP of 8 mm Hg was associated with successful outcomes in patients undergoing trabeculectomy. Also, younger age was found to be a risk factor for surgical failure.

Readmission Rates After Abdominal Surgery

To prospectively evaluate predictive factors of hospital readmission rates in patients undergoing abdominal surgical procedures. Recommendations from MedPAC that the Centers for Medicare and Medicaid Services (CMS) report upon and determine payments based in part on readmission rates have led to an attendant interest by payers, hospital administrators and far-sighted physicians. Analysis of 266 prospective treated patients undergoing major abdominal surgical procedures from September 2009 to September 2010. All patients were prospectively evaluated for underlying comorbidities, number of preop meds, surgical procedure, incision type, complications, presence or absence of primary and/or secondary caregiver, their education level, discharge number of medications, and discharge location. Univariate and multivariate analyses were performed. Two hundred twenty-six patients were reviewed with 48 (18%) gastric-esophageal, 39(14%) gastrointestinal, 88 (34%) liver, 58 (22%) pancreas, and 33 (12%) other. Seventy-eight (30%) were readmitted for various diagnoses the most common being dehydration (26%). Certain preoperative and intraoperative factors were not found to be significant for readmission being, comorbidities, diagnosis, number of preoperative medications, patient education level, type of operation, blood loss, and complications. Significant predictive factors for readmission were age (≥69 years), number of discharged (DC) meds (≥9 medications), ≤50% oral intake (52% vs. 23%), and DC home with a home health agency (62% vs. 11%) Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon’s performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.

Facoemulsificação e ciclofotocoagulação endoscópica como tratamento primário para catarata e glaucoma coexistentes

To evaluate the safety and efficacy of phacoemulsification and endoscopic cyclophotocoagulation (ECP) as a primary surgical treatment for glaucoma and cataract. Three hundred and sixty-eight eyes from 243 patients with primary open-angle glaucoma and cataract from the Centro Brasileiro de Cirurgia de Olhos that underwent an uncomplicated surgery from October, 1998 to December, 2006 with at least 2 years of follow-up were retrospectively enrolled. The patients were excluded if presented a previous ocular history of any intraocular surgery or glaucoma laser treatment. Qualified success was defined as 5 mmHg < intraocular pressure (IOP) < 21 mmHg with or without topical antiglaucomatous drugs, and complete success as the same IOP levels without therapy at all timepoints. Additionally, the requirement of any further glaucoma surgery was defined as failure. The mean follow-up was 35.15 + 8.14 months. The preoperative IOP (23.07 + 5.52 mmHg) was significantly greater than in the first postoperative day (13.14 + 6.09 mmHg), and months 1 (11.03 + 2.59 mmHg), 6 (12.33 + 3.01 mmHg), 12 (12.19 + 2.19 mmHg), 24 (12.14 + 2.89 mmHg) and in the last appointment (12.29 + 2.44 mmHg) (p<0.001 in all timepoints). The number of preoperative medications (1.44 + 0.97) decreased (0.37 + 0.74) (p<0.001). Furthermore, there was a significant improvement in the logMAR visual acuity (p=0.01). Three hundred and thirty-four eyes (90.76%) achieved qualified success, and 205 (55.7%) complete success. Complications included immediate postoperative IOP spike 14.4% (53/368), postoperative fibrin exudates in anterior chamber 7.06% (26/368), cystoid macular edema 4.34% (16/368), transitory hypotony 2.17% (8/368), iris bombé 1.08% (4/368). Phacoemulsification associated with endoscopic cyclophotocoagulation is safe and effective as a primary procedure for combined glaucoma and cataract.

Risk Factors for Uncontrolled Intraocular Pressure After Phacoviscocanalostomy

To determine factors affecting the outcome of phacoviscocanalostomy in patients with cataract and primary open-angle glaucoma. Factors for controlling intraocular pressure (IOP) were investigated in 180 patients using Cox multivariate proportional hazards survival regression. The mean preoperative IOP of 20.2+/-3.8 mm Hg decreased significantly (P<0.0001) to 15.3+/-2.6 mm Hg for 5 years postoperatively. The success probabilities defined as an IOP of 17 mm Hg or less or a 20% or greater reduction were 47.2% with or without medications and 31.4% without medications at 5 years. Preoperative IOP level [P=0.0013; odds ratio (OR), 1.14] and age (P=0.037; OR, 0.97) were risk factors in the success probability with or without medications. In the analysis without medications, the preoperative IOP (P<0.001; OR, 1.12), the preoperative number of antiglaucoma medications (P=0.033; OR, 1.27), age (P=0.003; OR, 0.96), and IOP spikes (P=0.028; OR, 1.22) were associated with failure. Sex, peeling of juxtacanalicular tissue, ruptured Descemet membrane, fibrin formation, and hyphema did not affect surgical outcomes. High preoperative IOP, the number of preoperative medications, postoperative IOP spikes (>30 mm Hg) increased the risk of failed IOP control after phacoviscocanalostomy. Increasing patient age decreased the risk of failure.

Outcome and risk factors for failure of primary trabeculectomy

Abstract Purpose: To evaluate the outcome and risk factors for failure in primary trabeculectomy in glaucoma patients. Methods: Medical record review of 59 patients (66 eyes) who underwent primary trabeculectomy from 2002 to 2006 at the Eye Hospital Ljubljana. Complete success was defined as intraocular pressure (IOP)≤18 mmHg without glaucoma medications, and failure as IOP&gt;18 mmHg with or without medications. Results: The mean preoperative IOP was 31,4 mmHg (±9,7) on an average of 2,5 glaucoma medications, and the mean postoperative IOP after 20 months was 16,8 mmHg (±6,4) on an average of 0,6 medications. Twenty months after trabeculectomy 51 of 66 eyes (77,3%) had an IOP≤18 mmHg without medical treatment. Ten of 15 eyes (66%) experienced failure within the 6 months after trabeculectomy. Using Kaplan‐Meier life table analysis the 3 and 5 year probability of an IOP≤18 mmHg without medication was 70%. After 3 years, the cumulative survival rates for eyes after trabeculectomy with mitomycin C (22 eyes), 5‐fluorouracil (31 eyes)and trabeculectomy without antimetabolite (13 eyes) were 78%, 77%, and 57%, respectively. Postoperative interventions (needling of filtering blebs and subconjuntival injections of 5‐fluorouracil) were associated with a higher rate of failure with the hazard ratio of 2,9 (P=0,04). Patients' age, number of preoperative medications, and cataract surgery were not significant predictive factors for failure. Conclusions: The outcome of primary trabeculectomy in our patients is comparable with that reported in other populations using the same criteria for success. More pronounced healing response after surgery necessitating needling of filtering blebs and subconjuctival injections of antimetabolite are associated with a higher risk for trabeculectomy failure.

The Effect of Mitomycin C on Molteno Implant Surgery

The authors assess whether adjunctive mitomycin C improves Molteno tube shunt surgery in terms of intraocular pressure (IOP), visual acuity, and complication rates. Twenty-five eyes of twenty-five consecutive patients undergoing double-plate Molteno implant surgery were randomized to receive either mitomycin C (MMC) 0.4 mg/mL for 2 minutes or a control balanced salt solution in a masked, prospective study. Intraocular pressure, visual acuity, and complications were recorded 1 week and 1, 3, 6, and 12 months after surgery. A repeated measures analysis of variance (ANOVA) model was used to test the overall effect of the drug on IOP and percent change from preoperative IOP. Thirteen eyes received balanced salt solution and 12 eyes received MMC. There was no difference between the groups with respect to age, preoperative IOP, log mean angle of resolution (LogMar) visual acuity, or number of preoperative medications. Except for week 1, there were no differences between the groups at any of the clinic visits with respect to IOP and percent change from baseline IOP. Analysis of the visual acuity (LogMar) showed reduction in vision for both groups. Complications were similar in each group, as were number of postoperative hypotensive agents required. Adjunct MMC does not demonstrate a significant difference in outcomes compared with placebo in pressure-ridged Molteno implant surgery. Results of this study are limited by a small number of patients in each group and a fixed dose of MMC.

Correlates of Length of Stay in Gynecologic Oncology Patients Undergoing Inpatient Surgery

Escalating economic constraints require identification of the determinants of length of stay (LOS), since optimizing these may facilitate cost-effective care. However, risk factors for increased LOS are poorly understood. In order to identify correlates of long LOS, we retrospectively reviewed the charts of 252 consecutive patients who underwent major inpatient surgery on the gynecologic oncology service at Barnes Hospital during 1990. Of these, 86 had benign disease and 38 were excluded for other reasons, leaving 128 for analysis. The recorded variables of age, race, medical history, measures of nutritional state, primary cancer, prior therapy, blood loss, operating time, and attending surgeon were subjected to regression analysis. In order to avoid reducing cell numbers to insignificant sizes, the linked factors of type of surgery and primary site were not analyzed simultaneously. A separate analysis was performed substituting type of procedure for primary site. The mean LOS was 12 days (range, 4-30). Five factors emerged as significant correlates of longer LOS: decreasing preoperative albumin level ( P < 0.001) and hemoglobin level (0.029), increasing age (0.017), operative blood loss (0.039), and prior platinum-based chemotherapy (0.043). Presence of vulvar and fallopian tube primaries was associated with significantly shorter LOS (0.023 and 0.037). Together these factors accounted for 36% of total variance in LOS. Substituting procedure type for primary site accounted for 37% of total variance in LOS and showed that only bowel surgery (0.001) and preoperative intracavitary implant were significantly correlated with longer LOS. Factors not associated with LOS ( P > 0.05) were race, attending physician, number of preoperative medications or medical conditions, body mass index, other radiotherapy, and other primary sites and procedures. Future studies should attempt to determine why elderly, nutritionally depleted women undergoing long or complicated procedures are at high risk for long LOS and should assess interventions designed to minimize LOS for this high-risk group.