Modelling the hospital length of stay for patients undergoing laparoscopic cholecystectomy through a multiple regression model

Abstract Introduction Developing formulas to predict accurate length of stay (LOS) is challenging in burn patients as many complex variables can effect LOS. A recently published article in 2016 provided new formulas (NFs) to predict hospital LOS. Our goal is to compare our patients actual LOS (ALOS) to the NFs published, the traditional 1day/%TBSA rule, and to the hospital expected LOS (ELOS) based on patients CMI/DRGs. Methods Data was collected from Jan ‘16 to Dec ‘18 on all patients >18 years of age using NTRACS burn registry. We excluded deaths, non-burns, readmissions, any records with missing information, and any patients transferred to another acute care hospital. We performed multiple regression to examine the relationship between LOS with age, inhalational injury (INHINJ), and TBSA on all patients. We divided this population into three groups per the NFs recommendations: 1) INHINJ; 2) without INHINJ < 40 years old; 3) without INHINJ >40 years old. Using these three groups, we calculated the difference between ALOS to 1) the traditional LOS formula, 2) the NFs as established in the 2016 article, and to 3) the hospitals ELOS metrics. For acuity comparison, we also calculated average CMI in each study group. The NFs published are as follows: Results The multiple regression model with all three variables (Age, % TBSA, and INHINJ) produced R² = 0.321, F(3,883) = 139.23, p < .05. INHINJ, age, and TBSA had significant positive regression, indicating an increase or presence of all three variables will lengthen LOS. The regression equation is: LOS = (-3.93) +1.71(AGE) +1.11(TBSA) +15.81 (Inhalation). Every year increase in age increased LOS by 1.71 days. Every 1% increase in TBSA increased LOS by 1.11 days. Presence of INHINJ (0= no INHINJ; 1= INHINJ) increased LOS by 15.81 days. Table 1 depicts the mean ± SD of the difference in LOS (predicted - actual) for the three predictive models of LOS. Negative values indicate underestimation of LOS and positive values indicate overestimate of LOS. Conclusions Application of the predictive LOS formulas has underestimated LOS in this population, with the exception of the NFs to predict LOS on patients >40 years old without INHINJ. Furthermore, an R² value of 0.32 indicates that the variables utilized in this study do not account for 68% of the variation we see. This is further exemplified by the wide standard deviations, particularly in the INHINJ group. Applicability of Research to Practice Directly Applicable.

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Risk factors on admission associated with hospital length of stay in patients with COVID-19: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-86853-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anping Guo ◽

Jin Lu ◽

Haizhu Tan ◽

Zejian Kuang ◽

Ying Luo ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Liver Disease ◽

Length Of Stay ◽

Regression Model ◽

Logistic Regression Model ◽

Hospital Length ◽

Clinical Treatment ◽

Hospital Length Of Stay ◽

Female Sex

AbstractTreating patients with COVID-19 is expensive, thus it is essential to identify factors on admission associated with hospital length of stay (LOS) and provide a risk assessment for clinical treatment. To address this, we conduct a retrospective study, which involved patients with laboratory-confirmed COVID-19 infection in Hefei, China and being discharged between January 20 2020 and March 16 2020. Demographic information, clinical treatment, and laboratory data for the participants were extracted from medical records. A prolonged LOS was defined as equal to or greater than the median length of hospitable stay. The median LOS for the 75 patients was 17 days (IQR 13–22). We used univariable and multivariable logistic regressions to explore the risk factors associated with a prolonged hospital LOS. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. The median age of the 75 patients was 47 years. Approximately 75% of the patients had mild or general disease. The univariate logistic regression model showed that female sex and having a fever on admission were significantly associated with longer duration of hospitalization. The multivariate logistic regression model enhances these associations. Odds of a prolonged LOS were associated with male sex (aOR 0.19, 95% CI 0.05–0.63, p = 0.01), having fever on admission (aOR 8.27, 95% CI 1.47–72.16, p = 0.028) and pre-existing chronic kidney or liver disease (aOR 13.73 95% CI 1.95–145.4, p = 0.015) as well as each 1-unit increase in creatinine level (aOR 0.94, 95% CI 0.9–0.98, p = 0.007). We also found that a prolonged LOS was associated with increased creatinine levels in patients with chronic kidney or liver disease (p < 0.001). In conclusion, female sex, fever, chronic kidney or liver disease before admission and increasing creatinine levels were associated with prolonged LOS in patients with COVID-19.

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Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

Diabetes Care ◽

10.2337/dc19-0963 ◽

2020 ◽

Vol 44 (1) ◽

pp. 107-115

Author(s):

Hsiu-Yin Chiang ◽

Kuan-Ting Robin Lin ◽

Ya-Luan Hsiao ◽

Han-Chun Huang ◽

Shih-Ni Chang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Glucose ◽

Length Of Stay ◽

Blood Glucose Level ◽

Glucose Level ◽

Hospital Length ◽

Hospital Length Of Stay

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Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

10.2337/figshare.13110221 ◽

2020 ◽

Author(s):

Kuan-Ting Robin Lin ◽

Hsiu-Yin Chiang ◽

Ya-Luan Hsiao ◽

Han-Chun Huang ◽

Shih-Ni Chang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Glucose ◽

Length Of Stay ◽

Missing Values ◽

Medical Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Adjusted Relative Risk ◽

Adjusted Risk ◽

Laparoscopic Cholecystectomy Group

OBJECTIVE To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values. RESULTS We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL. CONCLUSIONS We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.

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Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease

Journal of Hospital Administration ◽

10.5430/jha.v8n3p1 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1

Author(s):

Gregory S. Corwin ◽

Rebecca Reif ◽

Kevin W. Sexton

Keyword(s):

Linear Regression ◽

Length Of Stay ◽

Regression Model ◽

Linear Regression Model ◽

Medical Service ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Biliary Disease ◽

Surgical Service ◽

The Impact

Background: Biliary tract disease is a common condition often necessitating surgical intervention. It has been suggested that categorically admitting these patients to a surgical service rather than a medical service may improve patient outcomes. Our objective was to assess the impact of a protocol change that mandated preferentially admitting patients with biliary disease to a surgical service.Methods: This is a retrospective observational study of patients presenting with biliary disease to a single institution before and after a protocol change that mandated admitting these patients directly to a surgical service. A generalized linear regression model was conducted to analyze the effect of practice change on length of stay, which was primary studied outcome.Results: A total of 3,389 patients were included in the study (n = 1,866 for pre, and n=1,523 for post). There was no difference in hospital length of stay between pre and post groups for non-operative patients (1.9 days ± 4.3 versus 1.9 days ±5.2, p = .972). However, for operative patients, length of stay was shorter for the post group (4.1 days ± 6.1 vs 6.3 days ± 14.0, p = .066). The linear regression model found that operative patients had an increased probability of having a longer length of stay (coefficient, 0.21; 95% CI, 0.14, 0.29; p < .001).Conclusion: Admission of patients with biliary disease to a surgical service rather than a medical service is associated with shorter length of stay for patients who undergo an operative intervention. An approach of admitting all patients presenting with biliary disease to a surgical service has the potential to significantly reduce hospital costs. Our study supports primary responsibility for surgeons in the care of patients with potentially operative conditions.

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Finite mixture regression model with random effects: application to neonatal hospital length of stay

Computational Statistics & Data Analysis ◽

10.1016/s0167-9473(02)00180-9 ◽

2003 ◽

Vol 41 (3-4) ◽

pp. 359-366 ◽

Cited By ~ 31

Author(s):

Kelvin K.W. Yau ◽

Andy H. Lee ◽

Angus S.K. Ng

Keyword(s):

Length Of Stay ◽

Regression Model ◽

Random Effects ◽

Hospital Length ◽

Finite Mixture ◽

Hospital Length Of Stay ◽

Mixture Regression ◽

Finite Mixture Regression ◽

Mixture Regression Model

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Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

Anesthesiology ◽

10.1097/aln.0b013e3181ec642e ◽

2011 ◽

Vol 114 (4) ◽

pp. 882-890 ◽

Cited By ~ 98

Author(s):

Glenn S. Murphy ◽

Joseph W. Szokol ◽

Steven B. Greenberg ◽

Michael J. Avram ◽

Jeffery S. Vender ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Postanesthesia Care Unit ◽

Control Group ◽

Quality Of Recovery ◽

Pain Scores ◽

Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P < 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P < 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P < 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

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A predictive grading scale for acute cholecystitis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000324 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000324

Author(s):

Sammy Siada ◽

David Jeffcoach ◽

Rachel C Dirks ◽

Mary M Wolfe ◽

Amy M Kwok ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Acute Cholecystitis ◽

Hospital Length ◽

Systemic Inflammatory Response ◽

Hospital Length Of Stay ◽

Gallstone Pancreatitis ◽

Grading Scale

BackgroundAcute cholecystitis presents in a spectrum of severity, where acute disease may be complicated by severe inflammation, gangrene, and perforation. The goal of this study is to outline an evidence-based grading scale that predicts patient outcomes after laparoscopic cholecystectomy (LC).MethodsA retrospective review of all patients with a preoperative diagnosis of acute cholecystitis who underwent LC from August 2011 until June 2015 at a tertiary-level hospital was performed. Patients who underwent elective cholecystectomy, incidental cholecystectomy, a planned open cholecystectomy, had gallstone pancreatitis or choledocholithiasis, and those admitted to a non-surgical service were excluded. Severity of disease was obtained from operative and pathology reports, and patients were classified according to the following grading scale:Grade I: symptomatic cholelithiasis.Grade II: acute/chronic cholecystitis.Grade III: gangrenous/necrotizing cholecystitis.Grade IV: gallbladder perforation or abscess.The groups were compared on age, gender, body mass index, severity of gallbladder disease, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, length of operation, complications within 30 days, conversion to open rate, and cost of hospitalization.ResultsDuring the study period, 1252 patients who underwent laparoscopic cholecystectomy were analyzed; 677 met inclusion criteria. The most common grade was grade 2, which was present in 80% of patients, followed by grade 3, which was found in 16% of patients. Grade 4 cholecystitis occurred in 1.2% of patients and grade 1 occurred in 3.2% of patients. There were statistically significant increases in age, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, conversion to open rate, cost of hospitalization, and length of operation with increased cholecystitis grade.ConclusionsThe proposed grading scale is an accurate predictor of duration of operation, conversion to open rate, hospital length of stay, and cost of hospitalization.Level of evidenceIIIStudy typePrognostic

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Efficiency of Zero-Inflated Generalized Poisson Regression Model on Hospital Length of Stay Using Real Data and Simulation Study

Caspian Journal of Health Research ◽

10.29252/cjhr.3.1.5 ◽

2018 ◽

Vol 3 (1) ◽

pp. 5-9 ◽

Cited By ~ 2

Author(s):

Roghaye Farhadi Hassankiadeh ◽

Anoshirvan Kazemnejad ◽

Mohammad Gholami Fesharaki ◽

Siamak Kargar Jahromi ◽

◽

...

Keyword(s):

Length Of Stay ◽

Regression Model ◽

Simulation Study ◽

Poisson Regression ◽

Real Data ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Poisson Regression Model ◽

Generalized Poisson ◽

Generalized Poisson Regression

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Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

10.2337/figshare.13110221.v1 ◽

2020 ◽

Author(s):

Kuan-Ting Robin Lin ◽

Hsiu-Yin Chiang ◽

Ya-Luan Hsiao ◽

Han-Chun Huang ◽

Shih-Ni Chang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Glucose ◽

Length Of Stay ◽

Missing Values ◽

Medical Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Adjusted Relative Risk ◽

Adjusted Risk ◽

Laparoscopic Cholecystectomy Group

OBJECTIVE To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values. RESULTS We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL. CONCLUSIONS We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.

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