Does a shorter length of hospital stay affect the outcome and costs of hysterectomy in southern England ?
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.
Prospective cohort study.
Three hospitals in London and three in Hertfordshire and Bedfordshire.
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.
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). (...)
Mots-clés Pascal : Hystérectomie, Temps séjour, Hôpital, Postopératoire, Pronostic, Coût, Satisfaction, Homme, Femelle, Economie santé, Angleterre, Grande Bretagne, Royaume Uni, Europe, Chirurgie, Abdomen pathologie, Appareil digestif pathologie
Mots-clés Pascal anglais : Hysterectomy, Residence time, Hospital, Postoperative, Prognosis, Costs, Satisfaction, Human, Female, Health economy, England, Great Britain, United Kingdom, Europe, Surgery, Abdominal disease, Digestive diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0009478
Code Inist : 002B25G04. Création : 21/05/1997.