R. Victory

Predictors of Length of Stay for Inpatients Having Benign Gynaecological Surgery

OBJECTIVE To determine factors predictive of length of stay (LOS) for women in case-mix group (CMG) 579 (major uterine and [or] adnexal procedures-no malignancy). METHODS All inpatients having benign gynaecologic surgery in CMG 579 between April 1, 1997, and March 30, 1999, were studied. We obtained information from the hospital costing and registration database and from retrospective chart review. Abstracted data included patient demographics, age, admission weight, American Society of Anesthesiologists (ASA) risk score, pre- and postoperative diagnoses, procedure, surgeon, day of the week of surgery, LOS, and costs. Results were considered statistically significant when P </= 0.05. RESULTS There were 606 gynaecology inpatients in the study, with a mean age of 45.1 years. Women were categorized into 4 procedure groups: abdominal (59.2%), vaginal (26.7%), abdominal repair (pelvic floor relaxation) (9.5%), and other (4.6%) forms of surgery. The LOS was highly correlated with overall case costs. Univariable analyses indicated that procedure (R(2) = 0.22, P < 0.001), age (R(2) = 0.12, P < 0.001), surgeon (R(2) = 0.11, P < 0.001), postoperative diagnosis (R(2) = 0.11, P < 0.001), ASA score (R(2) = 0.09, P < 0.001), day of the week of surgery (R(2) = 0.03, P < 0.018), and weight (R(2) = 0.01, P < 0.017) were all determinants of LOS (all P < 0.001). Multivariable analyses demonstrated that the procedure, age, surgeon, postoperative diagnosis, and ASA score were the significant factors accounting for the most variance in LOS (R(2) = 0.46, P < 0.001). CONCLUSION The procedure performed, patients age, surgeon, postoperative diagnosis, and ASA score were significantly associated with length of stay. For better accuracy and validity, CMG-based comparisons of LOS should take these factors into account.

Oral contraceptives and cardiovascular disease: emerging evidence on potential associations with angina, myocardial infarction and stroke

Associations between combined estrogen/progestin oral contraceptives (OCs) and cardiovascular disease (CVD) have long been the focus of considerable concern. Initial, epidemiologic studies demonstrated increased risks of potential complications including deep venous thrombosis/pulmonary embolism, myocardial infarction and stroke. While the studies regarding venous thromboembolism consistently demonstrate at least some degree of risk associated with OC use, recent studies of both current and past OC users indicate that the association with arterial disease is dynamic, changing rapidly as OC formulations and OC-user populations change. As physicians increase selection, screening and monitoring of OC users, a healthier OC-user population is developing. Thus, many newer studies are demonstrating rates of angina and myocardial infarction that are either lower or the same as that of non-users, unless pre-existing risk factors are present leading to potential increases in risk of CVD. The evidence with regards to strokes is more complicated and controversial. While further study is necessary, current evidence suggests that OC use provides significant contraceptive benefits with minimal potential adverse effects in healthy users. The potential for CVD reduction in selected OC users merits the highest priority for further investigation.