Preoperative risk factors for extended hospital stay: A prospective study in a South African clinic.

Abstract

Background:  Preoperative assessment clinics play a critical role in identifying, evaluating and mitigating perioperative risks. Despite global data highlighting the importance of preoperative risk factors on surgical outcomes, there remains limited information on their impact on post-operative length of stay (LOS) in South African contexts.

Aim:  This study aimed to describe the demographic and clinical profiles of patients referred to a preoperative clinic as well as factors associated with post-operative extended LOS.

Setting:  The preoperative clinic is based in the city of Johannesburg in South Africa.

Methods:  This was a prospective cohort study conducted between 2021 and 2022 at a private clinic in patients undergoing non-cardiac surgery. Data on demographics, co-morbidities, surgical procedures and clinical outcomes were collected. Statistical analysis was performed to assess relationships between preoperative risk factors, including ASA grading, Revised Cardiac Risk Index (RCRI), estimated glomerular filtration rate, diabetes mellitus, age, obesity and LOS.

Results:  A total of 214 patients were assessed, of which 75.7% were female, with a median age of 62.5 years. Common co-morbidities included hypertension (59.3%) and obesity (55%). The median LOS was 3.5 days, with 47.2% of patients staying more than 3 days post-operatively. Knee (33.2%) and hip surgeries (21%) were the most common procedures. A significant association was found between longer LOS and RCRI score ≥ 1 (p = 0.007), renal dysfunction in knee surgery patients (p = 0.027) and age in patients undergoing hip surgery (p = 0.049).

Conclusion:  Findings note the need for targeted intereventions in preoperative care to reduce LOS, particularly for high-risk patients.Contribution: This study highlights the fact that preoperative information may play a significant role in patient's outcomes post surgery. Further research is needed to validate these results across broader healthcare settings.