Delineation of factors associated with prolonged length of stay after laparoscopic ventral hernia repair leads to a clinical pathway and improves quality of care

Jennifer Leonard, Tina J Hieken, Malek Hussein, W. Scott Harmsen, Mark D Sawyer, John Osborn, Juliane Bingener

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Centers for Medicare and Medicaid Services define laparoscopic ventral hernia repair (LVHR) as outpatient procedure. We identified our institutional length of stay (LOS) to be above the National Surgical Quality Improvement Program (NSQIP) benchmark of 1 day [interquartile range (IQR) 2 days]. This study was undertaken to investigate risk factors associated with prolonged hospital stay and design an intervention to decrease median LOS. Methods: This study analyzed institutional NSQIP data on patients who underwent elective LVHR from 2006 to 2011 to define factors associated with prolonged LOS, defined as LOS > 2 days. Modifiable factors identified in the initial analysis were included in a clinical care pathway to impact LOS. We repeated the NSQIP data analysis after implementation (4/2011–9/2012) to assess the effect of our intervention. Analysis was by univariate, ANOVA and logistic regression models. Results: During the pre-implementation period, 80 patients with a median age of 54 years (31–84) stayed a median of 2 days (IQR 3). On univariate analysis, factors associated with prolonged LOS included operative time, mesh size, amount of narcotics used and female gender. In multivariate analysis, operative time and narcotics used were associated with a prolonged LOS, C statistic = 0.88. Introduction of a clinical pathway focusing on non-narcotic pain relief resulted in a decrease in mean narcotic usage from 223 to 63 mg morphine equivalents/patient (p 

Original languageEnglish (US)
Pages (from-to)1614-1618
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2016

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Ventral Hernia
Critical Pathways
Quality of Health Care
Herniorrhaphy
Length of Stay
Narcotics
Quality Improvement
Operative Time
Logistic Models
Hospital Design and Construction
Centers for Medicare and Medicaid Services (U.S.)
Benchmarking
Morphine
Analysis of Variance
Outpatients
Multivariate Analysis
Pain

Keywords

  • Abdominal
  • Costs
  • Hernia
  • Pain
  • Quality control
  • Technical

ASJC Scopus subject areas

  • Surgery

Cite this

Delineation of factors associated with prolonged length of stay after laparoscopic ventral hernia repair leads to a clinical pathway and improves quality of care. / Leonard, Jennifer; Hieken, Tina J; Hussein, Malek; Scott Harmsen, W.; Sawyer, Mark D; Osborn, John; Bingener, Juliane.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 30, No. 4, 01.04.2016, p. 1614-1618.

Research output: Contribution to journalArticle

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