Agrawal S, et al. - In this population-based analysis, researchers studied the link between perioperative factors and prolonged length of stay (LOS) in women undergoing minimally invasive, abdominal, and vaginal hysterectomy. In large part, non-modifiable perioperative factors were noted to be the most important contributors to prolonged LOS for hysterectomy and suggested that targeted interventions to attenuate LOS will be challenging.

Methods

• Using the National Surgical Quality Improvement Program database, women from 2006-2015 who underwent benign hysterectomy were identified.
• LOS >75th percentile was the primary outcome.
• Individual predictors of prolonged LOS were determined by assessing demographic, preoperative, intraoperative, and postoperative factors.
• Using model fit statistics, the importance of each group of perioperative factors on prolonged LOS was evaluated.

Results

• A total of 157,589 women were identified, including 83,172 (52.8%) who underwent minimally invasive hysterectomy, 45,149 (28.6%) who underwent abdominal hysterectomy, and 29,268 (18.6%) who underwent vaginal hysterectomy.
• Researchers found that the 75^th percentile for LOS was 1 day for minimally invasive, 3 days for abdominal, and 2 days for vaginal hysterectomy.
• They found that the measured factors accounted for 11.0% of the ability to predict a prolonged LOS for minimally invasive, 20.3% for abdominal, and 16.2% for vaginal hysterectomy.
• Findings demonstrated that the most important contributors to LOS for minimally invasive and abdominal hysterectomy were intraoperative factors, while demographic factors dominated for vaginal hysterectomy.