Risk factors for prolonged hospital stay after surgery in older patients

Prolonged hospital stay after surgery is an important patient-centred outcome in older patients and is associated with increased healthcare costs. This case-control study aimed to identify risk factors for prolonged hospital stay in older patients having surgery. We matched 57 cases (patients 65 years of age or older, with a postoperative length of stay of greater than 21 days) with 165 controls (patients 65 years of age or older who underwent a comparable surgical procedure but were discharged home within 14 days). Patients had a greater risk of prolonged hospital stay if they had a history of cognitive impairment (odds ratio (OR) 2.41, 95% confidence interval (CI) 1.10 to 5.28, P=0.025), lung disease (OR 2.41, 95% CI 1.30 to 4.46, P=0.005) or past or current smoking (OR 1.58, 95% CI 1.14 to 2.19, P=0.009). Patients were also more likely to have longer hospital admission if they underwent emergency surgery (OR 1.26, 95% CI 1.12 to 1.41, P=0.002), were admitted to the intensive care unit (OR 4.57, 95% CI 2.80 to 7.56, P <0.001), had a blood transfusion (OR 4.83, 95% CI 2.92 to 7.96, P <0.001) or had any postoperative complication (OR 4.34, 95% CI 3.06 to 6.16, P <0.001). There were no significant differences in age, preoperative mobility status, or living arrangements between groups. In practice, these findings should assist clinicians and their patients in preoperative shared decision-making.