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J Am Coll Surg. 2008 Dec;207(6):904-13. doi: 10.1016/j.jamcollsurg.2008.08.015.

Risk factors for prolonged length of stay after urologic surgery: the National Surgical Quality Improvement Program.

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Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA.



Length of stay (LOS) is important, particularly as a marker for medical resource consumption. Determining which factors increase LOS can provide information on reducing costs and improving delivery of care. The objective of the current study was to identify patient preoperative and intraoperative risk factors for prolonged LOS after common urologic procedures.


Beginning in 2003, a trained surgical reviewer from the University of Michigan used National Surgical Quality Improvement Program protocols to abstract clinical data from urology surgery patients. Data were manually collected and then transmitted through the Internet to a secure National Surgical Quality Improvement Program Web site. Five hundred fifty-six patients were accrued between December 2003 and December 2004. Multiple variable logistic regression analysis was used to identify preoperative and intraoperative factors associated with prolonged LOS, defined as LOS > or = 75(th) percentile (in days) for each procedure category based on data from the Nationwide Inpatient Sample.


Overall, 7.3% of patients experienced prolonged LOS after urologic surgery. A history of previous cardiac surgery was the strongest independent predictor of prolonged LOS (odds ratio = 3.55; 95% CI, 1.60 to 7.74). Intraoperative process measures were also associated with prolonged LOS after common urologic procedures.


In this sample of urologic patients, prolonged LOS is associated with both preoperative and intraoperative factors. Preoperative factors, such as previous cardiac surgery and abnormal creatinine and hematocrit, were independently associated with a prolonged LOS and interoperative processes, such as length of operation and intraoperative transfusion. To help reduce costs and improve the quality of urologic care, efforts should be made to improve intraoperative processes and to minimize preoperative risk factors.

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