Risk factors for prolonged length of stay after major elective surgery

Objective Length of stay (LOS) is an important outcome as a marker of resource consum ption. Determining which factors increase LOS may provide information on re ducing costs and improving the delivery of care. The purpose of this study was to determine the independent association of intraoperative process of c are and postoperative events with prolonged LOS after adjusting for preoper ative severity of illness in patients undergoing major elective surgery. Methods Cases representing 11 elective operations from the National VA Surgical Qua lity Improvement Program were analyzed using multivariate logistic regressi on analysis. The outcome, prolonged LOS, was defined as an LOS greater than or equal to the 75th percentile (in days) for each operation. Hierarchical modeling was used to assess the independent association of groups of varia bles (preoperative patient characteristics, intra operative process of care , and postoperative adverse events) with prolonged LOS. Results For the 11 operations explored, there were 23,919 cases. Common preoperativ e variables associated with prolonged LOS were functional status, American Society of Anesthesiology class, and age. The most predictive intraoperativ e and postoperative variables included intraoperative blood transfusion, op erative time, return to the operating room, and the number of complications after surgery. Conclusions Prolonged LOS is associated with preoperative, intraoperative, and postoper ative factors. Although preoperative factors were independently associated with a prolonged LOS, the factors generating the highest risks for a prolon ged LOS were the intraoperative process of care and postoperative adverse e vents. To reduce costs, efforts should be made to improve the intraoperativ e process of care and to minimize postoperative complications.