title: The Relation between Obesity and Hospital Length of Stay after Elective Lateral Skull Base Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program.
abstract: OBJECTIVE
  Length of stay is a marker of quality and efficiency of health care delivery. The objective of this study was to identify preoperative, intraoperative, and postoperative variables that impact length of stay after lateral skull base surgery. Methods/Procedures: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2009-2012 were analyzed, and patients undergoing elective lateral skull base surgery for benign lesions of cranial nerves were identified. The primary outcome measure of interest was length of hospital stay. Protracted length of stay was defined as ≥75th percentile of length of stay for all patients. The impact of demographic factors, intraoperative variables, and postoperative complications on length of stay was assessed.
  
  
  RESULTS
  In total, 252 patients were included. Almost half of the patients (41.2%) were classified as obese (body mass index ≥30). Patients who were obese had significantly longer lengths of stay (5.6 ± 3.9 days) when compared to patients who were not obese (4.6 ± 3.4 days, p = 0.006). Multivariate regression analysis demonstrated that operative time, reoperation within 30 days of initial surgery, and obesity were independent predictors for protracted length of stay.
  
  
  CONCLUSIONS
  National multi-institutional data from the ACS-NSQIP suggest that operative time, reoperation, and obesity are predictors of longer hospital stays after lateral skull base approaches for benign cranial nerve neoplasms.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C., USA.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: O'Connell
authors.forename: Habib G
authors.initials: HG
authors.lastname: Rizk
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Stevens
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: Ted A
authors.initials: TA
authors.lastname: Meyer
mesh_terms: D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends*; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology