Determinants of hospital stay after modified radical mastectomy.
The most expeditious way of reducing surgical costs is through reducing hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative hospital stay for 73 consecutive patients undergoing modified radical mastectomy by 6 surgeons during a 12-month period. Stepwise logistic regression was used to identify independently significant preoperative variables associated with hospital stays equal to or greater than the median of 5 days. Intraoperative techniques and postoperative management were then evaluated using Cox proportional hazards model, with length of stay as the dependent variable after consideration for the significant independent preoperative factors. Age, history of heart disease, hypertension, diabetes, obesity, and American Society of Anesthesiologists (ASA) risk were significantly associated with prolonged stay (more than 4 days) in univariate analysis. Only age (P < 0.001) and cardiac history (P = 0.013) were significant independent predictors of hospital stay in multivariate analysis. After consideration for age and cardiac history, the only significant intraoperative or postoperative factor associated with hospital stay was the use of dressings incorporating Steri-Strips. This study suggests that the attribution of the reduction in hospital stay to discharge with drains in place is due to numerous factors, only one of which is the willingness to send patients home with the drains.
Tartter
P I
PI
Department of Surgery, Mount Sinai Medical Center, New York, New York 10029.
Beck
G
G
Fuchs
K
K
D000367:Age Factors; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D015411:Mastectomy, Modified Radical / Q000295:instrumentation / Q000379:methods; D008487:Medical History Taking; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors