title: Independent Preoperative Predictors of Prolonged Length of Stay after Laparoscopic Appendectomy in Patients Over 30 Years of Age: Experience from a Single Institution.
abstract: Prompt discharge after laparoscopic appendectomy (LA) is a marker of quality of care, fiscally desirable and feasible in select patients. Patients over 30 comprise a more heterogeneous cohort known to experience worse outcomes after LA. We aimed to identify easily available preoperative risk factors portending a postoperative length of stay ≥2 days among patients above age 30. In this investigation, 296 included patients from a single institution who underwent LA for acute appendicitis from 2010 to 2014 were retrospectively reviewed for preoperative demographics, laboratory studies, comorbidities, presentation characteristics, radiographic finding, and other rationally selected factors for association with postoperative length of stay ≥2 days. Bivariate and multivariate analysis was conducted to determine independent risk factors, which were subsequently modeled via receiver-operating characteristic curve generation and Kaplan-Meier analysis. "Classic" presentation [odds ratio (OR) = 0.5, P = .02], elevated red cell distribution width (RDW; OR = 1.5/% increase, P = 0.004) as well as evidence of rupture on CT (OR = 6.9, P < 0.001) were independently associated with postoperative length of stay ≥ 2 days. Modeling length of stay using these factors generated an area under the curve of 0.713 ± 0.037. Kaplan-Meier analysis of "classic" presentation, elevated RDW, and evidence of rupture on CT through the fifth postoperative day generated log-rank P values of 0.02, 0.05, and ≤ 0.001, respectively. In summary, lack of "classic" presentation, elevated RDW, and CT evidence of rupture are novel risk factors for prolonged postoperative length of stay in LA patients over 30. These findings may help target patients most appropriate for prompt discharge.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Wise
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Gadomski
authors.forename: Annette M
authors.initials: AM
authors.lastname: Ilg
authors.forename: Camilo
authors.initials: C
authors.lastname: Bermudez
authors.forename: Emily W
authors.initials: EW
authors.lastname: Chan
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Izmaylov
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Gridley
authors.forename: Jessica V
authors.initials: JV
authors.lastname: Kaczmarek
authors.forename: Sir Norman T
authors.initials: SN
authors.lastname: Melancon
authors.forename: Sarwat
authors.initials: S
authors.lastname: Ahmad
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Hocking
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kavic
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D057234:Preoperative Period; D011787:Quality of Health Care; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity