Evaluation of Factors Associated with Prolonged Hospital Stay Following Major General Surgical Procedures

Background: Longer length of stay for a major general surgery is linked to high health care costs, slow recovery process, and poor health care efficiency. Recognizing risk factors for prolonged length of stay may help to identify the patients who benefit from more aggressive perioperative care. Material and Methods: A prospective observational study was conducted among 320 adult patients undergoing major general surgical procedure. Some demographic, clinical, operative and postoperative parameters were prospectively collected. Longer hospital stay was considered as postoperative hospital stay more than the 75th percentiles (>10 days). Multivariate analyses were performed using multivariable logistic regression and factors associated with prolonged hospitalization were identified. Performance of models was evaluated by receiver operating characteristic (ROC) analysis and calibration test. Results: 82 patients had prolonged hospital stay (25.6%). Independent predictors included ICU admission (adjusted odds ratio [aOR] 4.02; 95% CI 2.00–8.09; p<0.001), operative duration >240 minutes (aOR 3.61; 95% CI 1.87–6.97; p<0.001), ASA physical status III–IV (aOR 3.15; 95% CI 1.60–6.21; p=0.001), and hypoalbuminemia (aOR 2.78; 95% CI 1.54–5.02; p<0.001). The prediction model has good discrimination (AUC 0.86, 95% confidence interval 0.81–0.91) and adequate calibration. Conclusion: Prolonged hospitalization after major general surgery is strongly associated with preoperative risk factors, operative complexity, and postoperative critical care requirements. Early identification of high-risk patients may support individualized perioperative management and improve surgical outcomes.

Keywords: Prolonged hospital stay; Length of stay; General surgery; Surgical outcomes; Predictive model; Logistic regression; Perioperative risk factors.