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. 2018 Jan 5;18(1):5.
doi: 10.1186/s12913-017-2817-8.

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

Siu Yin Lee  1 , Soo-Hoon Lee  2 , Jenny H H Tan  3 , Howard S L Foo  4 , Phillip H Phan  5 , Alfred W C Kow  1 , Sein Lwin  1 , Penelope M Y Seah  1 , Siti Zubaidah Mordiffi  1
Affiliations

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

Siu Yin Lee et al. BMC Health Serv Res. .

Abstract

Background: Patients 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.

Methods: A 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.

Results: Factors 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.

Conclusion: Our 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.

Keywords: Ambulatory services; Elective surgery; Intraoperative; Postoperative care; Preoperative; Prolonged length of stay.

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Conflict of interest statement

Ethics approval and consent to participate

This research was approved by the National Healthcare Group’s Domain Specific Review Board, Study #: 2015/00229, on April 7, 2015. This study draws on de-identified archival records and there was no requirement to obtain consent to participate.

Consent for publication

Not applicable

Competing interests

Siu Yin Lee, Soo-Hoon Lee, Jenny H.H. Tan, Howard S.L. Foo, Phillip H. Phan, Alfred W.C. Kow, Sein Lwin, Penelope M.Y. Seah, Siti Zubaidah Mordiffi report no relevant financial interests, activities, relationships, and affiliations competing of interests.

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