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Original Research

Open Access

Factors influencing length of hospital stay in patients using patient-controlled analgesia after laparotomy surgery-retrospective observational study

  • Hung-Chieh Chen1,†
  • Yu-Huan Tsou1,†
  • Chia-Kai Liu1
  • Kuan-Hung Chen1,*,
  • Chien-Hui Yang1,*,

1Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 83301 Kaohsiung, Taiwan

DOI: 10.22514/sv.2022.052

Submitted: 12 March 2022 Accepted: 29 April 2022

Online publish date: 18 July 2022

*Corresponding Author(s): Kuan-Hung Chen E-mail:
*Corresponding Author(s): Chien-Hui Yang E-mail:

† These authors contributed equally.


Multiple factors influencing the length of hospital stay (LOS) were investigated in patients using patient-controlled analgesia (PCA) after surgical laparotomy for various abdominal pathologies. Charts of patients who underwent fentanyl-based PCA for pain control after different types of exploratory laparotomy were reviewed retrospectively between January and December of 2014. Data from the preoperative, perioperative, and postoperative period were statistically analyzed using the Pearson’s correlation coefficient (PCC) and a multiple linear regression in relation to LOS. In the subgroup analysis, a significant positive correlation was found between an increased PCA-fentanyl dosage (µg/kg) and LOS in the gynecologic laparotomy-cancer (GyLC) group (PCC = 0.408; p < 0.05). In contrast, the PCA-fentanyl high dose (>500 µg/day) had a significant negative correlation with LOS in the general surgery-laparotomy-liver transplant-donor (GLLTD) group (PCC = −0.402; p < 0.05). Factors such as American Society of Anesthesiologists (ASA) classification, diabetes mellitus, hypertension, chronic kidney disease, age, surgical time, perioperative total fluid/urine/blood loss, blood transfusion, use of tetrastarch, vomit/pruritus during PCA use, and total amount of fentanyl use were demonstrated to be positively correlated with LOS in the various groups of patients. Only blood transfusion was a predictive variable for prolonged LOS in GyLC group. Chronic kidney disease, total perioperative fluid, and vomiting during PCA use were predictive of LOS in the gynecologic laparotomy-non-cancer (GyLNC) group. There are multiple factors that affect LOS in patients using PCA after laparotomy for various surgical procedures. Acute pain physicians should take the clinical situation into consideration when prescribing the postoperative opioid-PCA dosage.


Postoperative pain; Fentanyl; Opioid; Side effects; Recovery

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Hung-Chieh Chen,Yu-Huan Tsou,Chia-Kai Liu,Kuan-Hung Chen,Chien-Hui Yang. Factors influencing length of hospital stay in patients using patient-controlled analgesia after laparotomy surgery-retrospective observational study. Signa Vitae. 2022.doi:10.22514/sv.2022.052.


[1] Rawal N. Current issues in postoperative pain management. European Journal of Anaesthesiology. 2016; 33: 160–171.

[2] Buvanendran A, Fiala J, Patel KA, Golden AD, Moric M, Kroin JS. The incidence and severity of postoperative pain following inpatient surgery. Pain Medicine. 2015; 16: 2277–2283.

[3] Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce post-operative pulmonary complications after noncardiothoracic surgery: systematic review for the American college of physicians. Annals of Internal Medicine. 2006; 144: 596–608.

[4] Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. The Lancet. 2019; 393: 1537–1546.

[5] Ip HV, Abrishami A, PengPH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009; 111: 657–677.

[6] Lee B, Schug SA, Joshi GP, Kehlet H, Beloeil H, Bonnet F, et al. Procedure-specific pain management (PROSPECT) —an update. Best Practice & Research Clinical Anaesthesiology. 2018; 32: 101–111.

[7] Brown AK, Christo PJ, Wu CL. Strategies for postoperative pain management. Best Practice & Research Clinical Anaesthesiology. 2004; 18: 703–717.

[8] Ramsay MAE. Acute postoperative pain management. Baylor University Medical Center Proceedings. 2000; 13: 244–247.

[9] McNicol ED, Ferguson MC, Hudcova J. Patient controlled opioid analge-sia versus non-patient controlled opioid analgesia for postoperative pain. Cochrane Database of Systematic Reviews. 2015; 2015: CD003348.

[10] de Boer HD, Detriche O, Forget P. Opioid-related side effects: postopera-tive ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature. Best Practice & Research Clinical Anaesthesiology. 2017; 31: 499–504.

[11] Mark J, Argentieri DM, Gutierrez CA, Morrell K, Eng K, Hutson AD, et al. Ultrarestrictive opioid prescription protocol for pain management after gynecologic and abdominal surgery. JAMA Network Open. 2018; 1: e185452.

[12] Apfel C, Läärä E, Koivuranta M, Greim C, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91: 693–700.

[13] Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia. 2014; 118: 85–113.

[14] Oderda GM, Said Q, Evans RS, Stoddard GJ, Lloyd J, Jackson K, et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Annals of Pharmacotherapy. 2007; 41: 400–407.

[15] Gan TJ, Robinson SB, Oderda GM, Scranton R, Pepin J, Ramamoorthy S. Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries. Current Medical Research and Opinion. 2015; 31: 677–686.

[16] Pizzi LT, Toner R, Foley K, Thomson E, Chow W, Kim M, et al. Relationship between potential opioid-related adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2012; 32: 502–514.

[17] Koh JC, Lee J, Kim SY, Choi S, Han DW. Postoperative pain and intravenous patient-controlled analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 10,575 patients. Medicine. 2015; 94: e2008.

[18] Baldo BA, Pham NH. Histamine-releasing and allergenic properties of opioid analgesic drugs: resolving the two. Anaesthesia and Intensive Care. 2012; 40: 216–235.

[19] Dinges H, Otto S, Stay DK, Bäumlein S, Waldmann S, Kranke P, et al. Side effect rates of opioids in equianalgesic doses via intravenous patient-controlled analgesia: a systematic review and network meta-analysis. Anesthesia & Analgesia. 2019; 129: 1153–1162.

[20] Jang JS, Cho JY, Ahn S, Han H, Yoon Y, Choi Y, et al. Comparative performance of the complexity classification and the conventional major/minor classification for predicting the difficulty of liver resection for hepatocellular carcinoma. Annals of Surgery. 2018; 267: 18–23.

[21] Wu X, Li Z, Jiang Y, Bi X, Zhao H, Zhao J, et al. Comparison of the extent classification and the new complexity classification of hepatectomy for prediction of surgical outcomes: a retrospective cohort study. Journal of Gastrointestinal Surgery. 2019; 23: 2421–2429.

[22] Muangkaew P, Cho JY, Han H, Yoon Y, Choi Y, Jang JY, et al. Defining surgical difficulty according to the perceived complexity of liver resection: validation of a complexity classification in patients with hepatocellular carcinoma. Annals of Surgical Oncology. 2016; 23: 2602–2609.

[23] Aga Z, Machina M, McCluskey SA. Greater intravenous fluid volumes are associated with prolonged recovery after colorectal surgery: a retrospective cohort study. British Journal of Anaesthesia. 2016; 116: 804–810.

[24] Pillai VG , Chen CL. Living donor liver transplantation in Taiwan-challenges beyond surgery. Hepatobiliary Surgery and Nutrition. 2016; 5: 145–150.

[25] Abeles A, Kwasnicki RM, Pettengell C, Murphy J, Darzi A. The relationship between physical activity and post-operative length of hospital stay: a systematic review. International Journal of Surgery. 2017; 44: 295–302.

[26] Bower WF, Jin L, Underwood MJ, Lam YH, Lai PB. Peri-operative blood transfusion increases length of hospital stay and number of postoperative complications in non-cardiac surgical patients. Hong Kong Medical Journal. 2010; 16: 116–120.

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