[The influence of the clinical course and diagnosis on the length of surgical stays]. / L'influenza dell'iter clinico e diagnostico sulla durata delle degenze chirurgiche.

The length of stay (LOS) is one of the major determinants of rising costs in surgical patient care. We studied the timing of the diagnostic procedures performed in 323 surgical patients admitted to 8 surgical departments of a large hospital. Of these: 50 underwent gastrectomy, 28 colectomy, 90 biliary tract (BT) operation, 94 appendectomy and 61 saphenectomy. The average total and preoperative LOS were respectively 27 and 11 days in the gastrectomy group, 26 and 10 in the colectomy group, 10 and 4 in the appendectomy group, 20 and 11 in the BT group, 12 and 6 in the saphenectomy group. The LOS was not affected by the presence of a benign or malignant lesion in gastrectomy and colectomy. In the appendectomy and BT groups, patients admitted from the emergency room had a significantly lower total LOS when compared to elective admissions (8 vs 12 and 9 vs 21 days respectively, p < 0.01). The multiple regression model showed that global and preoperative LOS were influenced by the number of instrumental exams (contrastographic, endoscopic, echographic).

Analysis of diagnostic procedure costs for cerebrovascular disease admission to a highly specialized hospital.

Length of stay and hospital costs for cerebrovascular disease admissions depend on several hospital-, patient- and disease-related factors. To determine the incidence of each of these factors we studied 240 admissions for cerebrovascular diseases in a neurology division and in two medical divisions of a highly specialized hospital. Statistical analysis of the data collected from the case records revealed the effect of several factors. Some increased only the length of stay (severe neurological sequels on discharge; stay in general medicine, diagnosis of hemorrhage, arterial hypertension). Others increased investigation costs (length of stay, marital status), and costs were higher in a specialists ward. Length of stay was shorter where the nurse/bed ratio was higher. Old age and male sex were associated with a lower cost of diagnostic procedures.

[The length of pre- and postoperative surgical stays. The role of factors relative to the patient, to the type of intervention and to hospital services]. / Durata delle degenze chirurgiche pre e postoperatorie. Ruolo dei fattori relativi al paziente, al tipo di intervento e ai servizi ospedalieri.

The one-year most important and frequent surgical procedures performed in eight surgical departments of a large Italian general hospital were studied in order to describe the determinants of pre-, postoperative and total length of stay. The average length of stay (ALS) for the 724 hospitalized cases was 18.1 days (7.9 preoperative and 10.2 postoperative), with large variations in the preoperative ALS across the departments. Multiple regression analysis showed that total ALS was positively associated with age, type of surgical procedure and department of admission. Preoperative ALS was longer in intervention on colon (12 days) and stomach (11 days) than in saphenectomies (8 days) and in appendectomies (4 days). The degree of access to operating rooms was associated to preoperative ALS, while the type of intervention and age to postoperative ALS. ALS was reduced by the urgency of the case, the availability of diagnostic facilities in the department of admission and the patient's condition of student. Hospital's structure and organization need to be modified in order to reduce preoperative length of stay. The easier access of older patients to long-stay hospitals or home care would reduce postoperative length of stay.