Risk factors for prolonged hospitalization after gynecologic laparoscopic surgery.
OBJECTIVE
To determine perioperative risk factors for prolonged hospitalization after gynecologic laparoscopic surgery.


METHODS
Data on patients who underwent gynecologic laparoscopic surgery at a single academic institution from January 2000 to January 2009 were evaluated. Patient demographics, clinical history, intraoperative data, and postoperative adverse events were analyzed. Logistic regression analysis identified significant predictors of prolonged hospitalization (hospital stay>48 h after surgery). A risk score was created from the analysis to predict prolonged hospitalization.


RESULTS
Eight hundred seven patients were included. The median body mass index was 26.5 kg/m(2) (range, 14.2-72.3 kg/m(2)), and the median age was 49 years (range, 12-88 years). Four hundred fifty-nine patients (56.9%) underwent surgery for benign conditions, and 348 (43.1%) underwent surgery for malignant disease. A total of 78 patients (9.7%) had a prolonged hospitalization. Independent predictors of prolonged hospitalization were age>54 years (P<0.0001), operative blood loss>120 mL (P<0.0001), intraoperative or postoperative blood transfusion (P=0.0237), and early postoperative complication (P<0.0001). Having a prior laparoscopy was associated with a shorter hospital stay (P=0.0276). The risk score showed how changes in perioperative factors change the risk of prolonged hospitalization.


CONCLUSIONS
Factors such as age, blood loss, perioperative blood transfusion, and postoperative complications are associated with prolonged length of stay after laparoscopic surgery, while having a prior laparoscopy is associated with a shorter hospital stay. A clinical scoring system can be used to estimate probability of prolonged hospitalization after gynecologic laparoscopic surgery.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Behrouz
B
Zand
Michael
M
Frumovitz
Matias F
MF
Jofre
Alpa M
AM
Nick
Ricardo
R
Dos Reis
Mark F
MF
Munsell
Haleh
H
Sangi-Haghpeykar
Charles
C
Levenback
Pamela T
PT
Soliman
Kathleen M
KM
Schmeler
Pedro T
PT
Ramirez
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001810:Blood Volume; D015992:Body Mass Index; D002648:Child; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D055815:Young Adult