LENGTH OF STAY AND DIRECT COST OF CARE AMONG SURGICAL INPATIENTS AT UNIVERSITY OF COLLEGE HOSPITAL, IBADAN

Abstract

Minimising hospital length of stay (LOS) has been shown to be of importance to eliminate unnecessary resource use without sacrificing, patient care and safety. Yet few studies exist in published literatures that document the LOS of surgical inpatients in Nigeria. This study was conducted to assess the LOS among surgical inpatients, identify factors associated with prolonged hospital stay among them and estimate the direct cost of hospital stay. A retrospective review of records inpatients that had surgery from January to December, 2010 was conducted. Data was collected with the aid of a semi-structured pro-forma. Information was collected on socio-demographic variables, LOS, investigations, drugs and other variables on procedure performed and cost of care. Prolonged LOS was defined as >7 days. Cost was estimated using hospital billing documents used at the period studied. Chi square test and Pearson correlation coefficient were used to test association of potential factors which are likely to be associated with LOS. Logistic regression was used to identify the determinants of prolonged LOS using odds ratio at 95% Confidence Interval. Mean cost of care were compared using t-test and Analysis of variance (ANOVA). Linear regression analysis was used to determine the predictors of increasing cost of care. Level of significance of 5% was used. The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were 257(63.6%) and Christians were 143 (35.4%). Median LOS was 11 days with an inter-quartile range of 5-20 days. In all, 254(63%) had prolonged stay. The mean overall cost of care was N66,983 ± N31,985. Cost of surgery is about 50% of total cost of care. LOS had positive and significant correlation with only duration of - surgery r = 0.25. The determinants of prolonged LOS were Islamic religion [OR: 1.7 (1.04- 2.92)] versus Christianity, plastic surgery [OR: 4.5(1.3- 15.3)], emergency surgery [OR: 2.1(1.2- 3.8)] versus elective surgery, ASA grade II [OR: 2.2(1.2- 4.2)], presence of blood transfusion [OR: 2.1(1.01- 4.53)] versus no blood transfusion. Patient first seen at the Accident and Emergency had a significantly higher mean cost of care of p = Nl 1,986 compared to others that were first seen at Children Outpatient Clinic, Gynaecology Clinic and Eye Clinic. (95% CI: N297 to N23,674). Other determinants of increase cost were ASA II, (Beta=N 12,382), ASA III(Beta= 16, 11 7), ASA IV (Beta=16,489) versus ASA I. Neuro Surgery (Beta=N29,755) versus General Surgery, General Anaesthesia (Beta=N14,513) versus Local Anaesthesia, Blood loss above 1000mls (Beta=N 15,922) versus Blood loss of less than 500 mls, Blood transfusion (Beta=N14,437) versus no transfusion all contributed to cost of care significantly. Prolonged LOS was experienced by a high proportion of surgical inpatient at University College Hospital, Ibadan. Most of the factors associated are non modifiable. There is therefore an urgent need for a prospective research to follow up patients from admission to discharge to identify hospital related factors responsible for prolonged LOS and make recommendations.