DOES A SHORTER LENGTH OF HOSPITAL STAY AFFECT THE OUTCOME AND COSTS OF HYSTERECTOMY IN SOUTHERN ENGLAND

Study objective - To see whether a shorter postoperative length of sta y (LOS) for a major procedure, abdominal hysterectomy for benign condi tions, was associated with health outcome, the use of formal and lay c are after discharge, cost, and satisfaction. Design - Prospective coho rt study. Setting - Three hospitals in London and three in Hertfordshi re and Bedfordshire. Patients - A total of 363 women undergoing total abdominal hysterectomy with or without oophorectomy: 112 with a short postoperative LOS (five days or less) and 251 with a standard LOS (six days or more). Main outcome measures - Wound infection within 10 days and six weeks; change in general health status (Nottingham health pro file) after six weeks; general health and change in social activity (l ifestyle index) three months after surgery. Mean cost difference for h ospitals, use of formal and lay care after discharge, and patient sati sfaction. Results - Short LOS was associated with benefits: a lower ri sk of wound infection in the first 10 days (odds ratio 0.44; p = 0.03) and no deterioration in physical mobility (measured using the NHP) af ter six weeks - and with adverse outcomes: constipation six weeks late r (OR 0.48; p < 0.001) and moderate or severe urinary symptoms six wee ks (OR 0.69; p < 0.004) and three months (OR 0.65; p < 0.008) later. O n multivariate analysis, the only outcome to remain significantly asso ciated with LOS was physical mobility after six weeks (p = 0.024). The re was no significant difference between short and standard stay women as regards their use of formal or lay care after discharge from hospi tal. The mean cost of hospital care was pound 251 (in 1992) less for s hort than for standard stay patients. Most women (73% at six weeks) fe lt their LOS was appropriate. Short stay women were more likely to fee l it was too short, though the difference was not statistically signif icant. Conclusions - Short postoperative stays do not seem to be assoc iated with any adverse outcomes and result in modest financial saving to the health service.