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

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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