American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Length of stay after emergency procedures hinges mostly on institutional factors

OCTOBER 23, 2018
Clinical Congress Daily Highlights, Tuesday Second Edition

What happens after an emergency procedure explains far more variation in length of hospital stay than other factors. An analysis of more than 200,000 emergency procedures finds that how ill the patient is matters less than variables such as postoperative complications or quality of care in determining how long a patient spends in the hospital.

The findings suggest that there’s a lot of room for improvement in issues related to length of hospital stay — and that they have little to do with the work of the surgeon, said medical student Aditya Achanta, Massachusetts General Hospital, Boston, MA.

Length of stay is often used as a proxy for hospital quality, and bringing down length of stay can bring down costs. A team led by Haytham Kaafarani, MD, FACS, MPH, Massachusetts General Hospital, decided to look at the role of clinical variables in explaining length of stay for patients undergoing emergency procedures. Such procedures made up about 7 percent of hospitalization nationwide from 2001 to 2010, and have a disproportionately high rate of mortality and morbidity. In 2010 alone, the cost of hospitalization for emergency procedures was upwards of $28 billion.

Using the 2007-2015 ACS National Surgical Quality Improvement Program database, the team looked at 226,632 patients. Procedures included emergency appendectomy, cholecystectomy, colectomy, enterectomy, enterolysis, or herniorrhaphy. Then the team created a multivariate regression model that included demographic, preoperative (comorbidities, laboratory variables), intraoperative (duration of surgery, wound classification), and postoperative variables (complications).

Only 25 to 41 percent of the variation in length of stay was explained by clinical factors. Further research taking a more fine-grained look at the nonclinical factors could reveal which factors are most worth addressing.

To view this study’s abstract, click here.

The Scientific Forum, General Surgery IV, was held October 23 at the 2018 Clinical Congress of the American College of Surgeons in Boston, MA. Program, webcast and audio information is available online at

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