Leslie S Anewenah, MD1, Shivani Shah2, Carissa Jeannette2, Mohammad Khan, MD1, Piotr Krecioch, MD1, John Fobia, MD1, Prashanth Ramachandra, MD1, Leon Clarke, MD1. 1Mercy Catholic Medical Center, 2Philadelphia College of Osteopathic Medicine
Background and Objective: Hospitals and healthcare systems across the country are under increasing pressures to reduce costs and improve patient outcomes. One area that has gained the attention of administrators is the hospital length of stay (LOS). The purpose of this study is to identify drivers of LOS after a cholecystectomy.
Methods: Institutional review board approval was requested and obtained. A retrospective review of all patients undergoing cholecystectomy (CLY) from June 2012 to May 2016 was undertaking at a community hospital. Data collected and analyzed include gender, age, American Society of Anesthesiologist score (ASA), body mass index (BMI), comorbidities, operative time, type of CLY, length of stay (LOS), endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiogram (IOC), comorbidities and complications within 30 days of surgery. Linear regression analysis was performed using IBM® SPSS® 24 software.
Results: There were 907 CLY performed at our institution, of which 878 (97%) were performed with laparoscopy. Females composed of 678 (75%) patients and the median age was 48 years old (18 to 95). ASA of the patients included: I 32 (4%), II 391 (43%), III 433 (48%) and IV 50 (6%). BMI ranged from 14 to 66 kg\m2 (median 32 kg\m2). The median operative time was 75 minutes (15 to 372). 147 (16%) complications within 30 days were noted. The complication grades included: grade I 41 (28%), grade II 87 (59%), grade III 12 (8%), grade IV 3 (2%) and grade V 4 (3%). LOS for this series of patients ranged from 0 to 52 days (Mean = 3 and Median 2). When the linear regression model was analyzed, gender (p=0.002), conversion to an open procedure (p<0.001), ASA (p<0.001), acute pancreatitis (AP) (p<0.001), Congestive heart failure (CHF) (p<0.001), chronic kidney disease (CKD) (p=0.002) and ERCP (p<0.001) were significant factors that influenced the LOS. In particular, the conversion from laparoscopic cholecystectomy to open cholecystectomy increased the LOS by 3 days; patients with CHF had their stay extended by 3.6 days and ERCP increased LOS by 2 days. Diabetes Mellitus (p=0.662), complications (p=0.589) and BMI (0.143) were not significant drivers of LOS.
Conclusion: The factors influencing the LOS after CLY are multifocal. This study provides a list of LOS drivers that can be targeted with interventions to reduce LOS.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80647
Program Number: P659
Presentation Session: Poster (Non CME)
Presentation Type: Poster
