Table 3.
Prospective studies of risk factors associated with prolonged hospitalization among older adults undergoing elective surgery
| Study | Number of patients | Overall length of hospitalization (days) | Factors associated with prolonged hospitalization | Factors not associated with prolonged hospitalization | |
|---|---|---|---|---|---|
| Median | IQR | ||||
| Audisio, 2008 [1] | 460 | 5 | 3-70 | Male sex (8 vs. 4 days, P < 0.005), more advanced cancer (2 vs. 11.5 days, P < 0.001), ADL dependent (RR 2.01, 95% CI 1.37–2.93), IADL dependent (RR 1.58, 95% CI 1.11–2.24), performance status abnormal (RR 1.64, 95% CI 1.06–2.56) | Age, MMSE abnormal (RR 1.18, 95% CI 0.76–1.86), GDS depressed (RR 1.30, 95% CI 0.91–1.85), ASA abnormal (RR 0.85, 95% CI 0.60–1.20), Satariano’s index (RR 1.23, 95% CI 0.85–1.78) |
| Badgwell, 2013 [2] | 111 | NR | NR | Cancer stage (distant vs. localized/regional) (OR 0.37, 95% CI 0.15–0.91), weight loss ≥ 10% (OR 4.03, 95% CI 1.13–14.43), polypharmacy (OR 2.45, 95% CI 1.09–5.48) | ASA score ≥ 2 (OR 1.02, 95% CI 0.39–2.69), ECOG performance status (OR 1.68, 95% CI 0.70–4.04) |
| Blakoe, 2015 [61] | 79 | NR | NR | NR | Frailty |
| Clement, 2011 [24] | 1343 | NR | NR | Age (Pearson’s coefficient 0.21, P < 0.001) | NR |
| Dasgupta, 2009 [7] | 125 | NR | NR | Age (P = 0.0074), Edmonton Frailty Scale score (P = 0.0042) | NR |
| Gerude, 2014 [30] | 67 | 7a | 2–26b | Smoking habit (OR 11.0, 95% CI 1.5–81.1), arm circumference ≤ 25 cm (OR 7.2, 95% CI 1.2–44.6), male sex (RR 2.15, 95% CI 1.10–4.18)a, IADL dependence (RR 1.97, 95% CI 1.07–3.61)a, underweight BMI (RR 2.23, 95% CI 1.19–4.55)a | Age > 78 years (RR 0.98, 95% CI 0.56–1.74), alcoholism (RR 0.84, 95% CI 0.47–1.48), ADL dependence (RR 0.94, 95% CI 0.47–1.89), advanced cancer stage (RR 1.64, 95% CI 0.60–4.49), type 2 diabetes mellitus (RR 2.28, 95% CI 0.63–8.13), hypertension (RR 1.21, 95% CI 0.63–8.13), COPD (RR 0.62, 95% CI 0.33–1.16), overweight BMI (RR 1.37, 95% CI 0.55–3.41), type 1 diabetes mellitus (RR 1.02, 95% CI 0.53–1.96), Karnofsky index ≤ 80 (RR 1.69, 95% CI 0.97–2.94), albumin ≤ 4.3 mg/dL (RR 1.10, 95% CI 0.63–2.02) |
| Green, 2012 [39] | 159 | NR | NR | Frailty (9 ± 6 days vs. 6 ± 5 days, P = 0.004) | NR |
| Huisman, 2014 [31] | 280 | NR | NR | TUG test > 20 s (OR 3.98, 95% CI 1.12–14.10), ASA score 2 (OR 0.23, 95% CI 0.05–0.99) | ASA score > 2 (OR 0.37, 95% CI 0.08–1.68) |
| Kenig, 2015 [36] | 75 | 12 | 3–42 | Frailty + postoperative complications (10.4 vs. 20.3 days, P < 0.001) | Frailty without postoperative complications (12.7 vs. 16.9 days, P = 0.19) |
| Kim, 2013 [51] | 141 | 14 | 7–28 | Cumulative number of impairments in CGA domains (P = 0.005) | NR |
| Kim, 2016 [37] | 197 | NR | NR | Mobility assessment tool – short form (HR 0.81, 95% CI 0.68–0.96), ASA status ≥ 3 (HR 1.65, 95% CI 1.11–2.46), intermediate- or high-risk surgery (HR 2.83, 95% CI 1.84–4.36), hs-CRP (HR 1.40, 95% CI 1.02–1.92) | Intermediately frail/frail (HR 1.13, 95% CI 0.79–1.60) |
| Kothari, 2011 [45] | 60 | NR | NR | Question 1 (6.55 ± 1.02 vs. 4.89 ± 0.84 days, P = 0.039), 9 (7.15 ± 1.16 vs. 5.04 ± 0.76 days, P = 0.01), and 10 (18.5 ± 9.50 vs. 5.04 ± 0.54 days, P = 0.031) of the NSI NHC | NR |
| Lasithoiotakis, 2013 [35] | 57 | NR | NR | Frailty (OR 4.2, 95% CI 1.3–13.5) | Age ≥ 75 years (OR 0.7, 95% CI 0.2–2.2), ASA score ≥ 3 (OR 5.6, 95% CI 0.8–35.8) |
| Makary, 2010 [29] | 594 | NR | NR | Frailty (IRR 1.69, 95% CI 1.28–2.23) | NR |
| Papaioannou, 2005 [27] | 47 | NR | NR | NR | General anesthesia (OR 2.50, 95% CI 0.74–8.46) |
| Reinohl, 2015 [59] | 110 | NR | NR | NR | Atrial fibrillation (P = 0.171), EuroScore I (P = 0.067), EuroScore II (P = 0.210), STS score (P = 0.220) |
| Robinson, 2012 [25] | 186 | 12a | 12c | Impaired cognition (15 ± 14 vs. 9 ± 9, P = 0.001) | NR |
| Rogers, 1989 [58] | 46 | 14.5a | 4.5c | Knee joint vs. hip (beta coefficient 4.3, standard error 1.3, P = 0.0021) | Osteoarthritis vs. rheumatoid arthritis (beta coefficient 1.3, SE 1.4, P = 0.3676) |
| Schmidt, 2015 [60] | 652 | 9 | 7–14 | TUG test > 21 s (regression coefficient 2.91, 95% CI 0.24–5.58, P = 0.03), malnutrition on MNA (regression coefficient 6.99, 95% CI 3.02–10.96, P = 0.001) | Above high school education (regression coefficient 0.18, 95% CI –0.79 to 1.15, P = 0.71), age (regression coefficient 0.08, 95% CI –0.23 to 0.19, P = 0.13), sex (regression coefficient 0.08, 95% CI –1.04 to 1.25, P = 0.86), tumor site (genitourinary vs. gastrointestinal) (regression coefficient –1.19, 95% CI –2.40 to 0.02, P = 0.05) |
| van Venrooij, 2009 [46] | 100 | NR | NR | NR | Protein intake > 0.98 g/kg actual body weight (OR 0.857, 95% CI 0.376–1.956), protein intake > 0.98 g/kg ideal body weight (OR 0.857, 95% CI 0.376–1.956), energy intake > 21.3 kcal/kg actual body weight (OR 1.221, 95% CI 0.535–2.786), energy intake > 22.2 kcal/kg ideal body weight (OR 1.221, 95% CI 0.535–2.786) |
| Williams, 2013 [53] | 148 | NR | NR | NR | Anxiety vs. none (OR 1.20, 95% CI 0.30–4.87) |
aMean
bRange
cStandard deviation
ADLs activities of daily living, ASA American Society of Anesthesiologists, BMI body mass index, COPD chronic obstructive pulmonary disease, ECOG Eastern Cooperative Oncology Group, GDS geriatric depression scale, hs-CRP high sensitivity C-reactive protein, IADLs instrumental activities of daily living, MMSE Mini Mental State Exam, MNA Mini Nutritional Assessment, NSI NHC Nutrition Screening Initiative Nutritional Health Checklist, TUG timed up and go, CI confidence interval, HR hazard ratio, IQR interquartile range, NR not reported, OR odds ratio, RR relative risk