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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1996 Oct;50(5):545–550. doi: 10.1136/jech.50.5.545

Does a shorter length of hospital stay affect the outcome and costs of hysterectomy in southern England?

A Clarke 1, P Rowe 1, N Black 1
PMCID: PMC1060348  PMID: 8944863

Abstract

STUDY OBJECTIVE: To see whether a shorter postoperative length of stay (LOS) for a major procedure, abdominal hysterectomy for benign conditions, was associated with health outcome, the use of formal and lay care after discharge, cost, and satisfaction. DESIGN: Prospective cohort study. SETTING: Three hospitals in London and three in Hertfordshire and Bedfordshire. PATIENTS: A total of 363 women undergoing total abdominal hysterectomy with or without oophorectomy: 112 with a short postoperative LOS (five days or less) and 251 with a standard LOS (six days or more). MAIN OUTCOME MEASURES: Wound infection within 10 days and six weeks; change in general health status (Nottingham health profile) after six weeks; general health and change in social activity (lifestyle index) three months after surgery. Mean cost difference for hospitals, use of formal and lay care after discharge, and patient satisfaction. RESULTS: Short LOS was associated with benefits: a lower risk of wound infection in the first 10 days (odds ratio 0.44; p = 0.03) and no deterioration in physical mobility (measured using the NHP) after six weeks- and with adverse outcomes: constipation six weeks later (OR 0.48; p < 0.001) and moderate or severe urinary symptoms six weeks (OR 0.69; p < 0.004) and three months (OR 0.65; p < 0.008) later. On multivariate analysis, the only outcome to remain significantly associated with LOS was physical mobility after six weeks (p = 0.024). There was no significant difference between short and standard stay women as regards their use of formal or lay care after discharge from hospital. The mean cost of hospital care was Pounds251 (in 1992) less for short than for standard stay patients. Most women (73% at six weeks) felt their LOS was appropriate. Short stay women were more likely to feel it was too short, though the difference was not statistically significant. CONCLUSIONS: Short postoperative stays do not seem to be associated with any adverse outcomes and result in modest financial saving to the health service. There is potential for greater use of early discharge.

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Selected References

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  1. Adler M. W., Waller J. J., Creese A., Thorne S. C. Randomised controlled trial of early discharge for inguinal hernia and varicose veins. J Epidemiol Community Health. 1978 Jun;32(2):136–142. doi: 10.1136/jech.32.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Adler M. W., Waller J. J., Day I., Kasap H. S., King C., Thorne S. C. A randomized controlled trial of early discharge for inguinal hernia and varicose veins: some problems of methodology. Med Care. 1974 Jun;12(6):541–547. doi: 10.1097/00005650-197406000-00007. [DOI] [PubMed] [Google Scholar]
  3. Anderson P., Meara J., Brodhurst S., Attwood S., Timbrell M., Gatherer A. Use of hospital beds: a cohort study of admissions to a provincial teaching hospital. BMJ. 1988 Oct 8;297(6653):910–912. doi: 10.1136/bmj.297.6653.910. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Breslau N. A., Padalino P., Kok D. J., Kim Y. G., Pak C. Y. Physicochemical effects of a new slow-release potassium phosphate preparation (UroPhos-K) in absorptive hypercalciuria. J Bone Miner Res. 1995 Mar;10(3):394–400. doi: 10.1002/jbmr.5650100309. [DOI] [PubMed] [Google Scholar]
  5. Burns L. R., Wholey D. R. The effects of patient, hospital, and physician characteristics on length of stay and mortality. Med Care. 1991 Mar;29(3):251–271. doi: 10.1097/00005650-199103000-00007. [DOI] [PubMed] [Google Scholar]
  6. Clarke A., Black N., Rowe P., Mott S., Howle K. Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study. Br J Obstet Gynaecol. 1995 Aug;102(8):611–620. doi: 10.1111/j.1471-0528.1995.tb11398.x. [DOI] [PubMed] [Google Scholar]
  7. Cleary P. D., Greenfield S., Mulley A. G., Pauker S. G., Schroeder S. A., Wexler L., McNeil B. J. Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA. 1991 Jul 3;266(1):73–79. [PubMed] [Google Scholar]
  8. Evans R. G., Robinson G. C. Surgical day care: measurements of the economic payoff. Can Med Assoc J. 1980 Nov 8;123(9):873–880. [PMC free article] [PubMed] [Google Scholar]
  9. Flood A. B., Ewy W., Scott W. R., Forrest W. H., Jr, Brown B. W., Jr The relationship between intensity and duration of medical services and outcomes for hospitalized patients. Med Care. 1979 Nov;17(11):1088–1102. doi: 10.1097/00005650-197911000-00002. [DOI] [PubMed] [Google Scholar]
  10. Jönsson B., Lindgren B. Five common fallacies in estimating the economic gains of early discharge. Soc Sci Med Med Econ. 1980 Mar;14(1):27–33. doi: 10.1016/0160-7995(80)90005-2. [DOI] [PubMed] [Google Scholar]
  11. McPherson K. Length of stay and health outcome. Br Med J (Clin Res Ed) 1984 Jun 23;288(6434):1854–1855. doi: 10.1136/bmj.288.6434.1854. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Morris D., Ward A. W., Handyside A. J. Early discharge after hernia repair. Lancet. 1968 Mar 30;1(7544):681–685. doi: 10.1016/s0140-6736(68)92114-4. [DOI] [PubMed] [Google Scholar]
  13. Russell I. T., Devlin H. B., Fell M., Glass N. J., Newell D. J. Day-case surgery for hernias and haemorrhoids. A clinical, social, and economic evaluation. Lancet. 1977 Apr 16;1(8016):844–847. doi: 10.1016/s0140-6736(77)92790-8. [DOI] [PubMed] [Google Scholar]

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