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/m² (range, 14.2-72.3 kg/m²), 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.

Conclusion

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.