Factors Contributing to Extended Hospital Length of Stay in Emergency General Surgery^†

Abstract

Background

Emergency general surgery (EGS) is a field characterized by disproportionately high costs, post-operative mortality, and complications. We attempted to identify independent factors predictive of an increased postoperative length of stay (LOS), a key contributor to economic burden and worse outcomes.

Methods

The ACS-NSQIP database was queried for data from2005 to 2017. Current procedural terminology (CPT) codes were used to identify the most commonly performed EGS procedures: appendectomy, bowel resection, colectomy, and cholecystectomy. Cohorts above and below 75^th percentile LOS were determined, compared by preoperative variables, and evaluated with univariate and multivariate logistic regression to quantify risk.

Results

Of 267,495 cases, 70,703 cases were above the 75^th percentile for LOS. A larger proportion of patients in the extended LOS group were 41 years or older (88.6% vs 45.7%). More Blacks (10.3% vs 6.7%) were observed in the extended LOS group. Age, race, cardiopulmonary, hepatic, and renal disease, diabetes, recent weight loss, steroid use, and sepsis history were significant factors on multivariate analysis but varied in terms of risk proportion by procedure. Age (61+), Black race, hypertension, sepsis, and cancer were significant for all 4 procedures.

Conclusions

Several factors are independently associated with extended LOS for those undergoing the most common EGS procedures. Five of these were associated with an increased LOS for all four procedures. These included, age (61+), hypertension, sepsis, cancer, and Black race.

Keywords:

• Emergency
• general surgery
• NSQIP
• length of stay

This article is referred to by:

Emergency General Surgery: Let’s Get It Right from the Beginning!

Acknowledgements

All authors have seen and approved the final version of the manuscript being submitted and all authors fulfill the COPE (Committee on Publication Ethics) requirements for authorship

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding 

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research study has not been previously published or submitted elsewhere for publication and will not be sent to another journal until a decision is made concerning publication by Journal of Investigative Surgery.

Data availability

The data that support the findings of this study are available upon request in the American College of Surgeons National Surgical Quality Improvement Program database [https://www.facs.org/quality-programs/acs-nsqip].