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Table 3 Prospective studies of risk factors associated with prolonged hospitalization among older adults undergoing elective surgery

From: Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

Study Number of patients Overall length of hospitalization (days) Factors associated with prolonged hospitalization Factors not associated with prolonged hospitalization
Median IQR
Audisio, 2008 [1] 460 5 3-70 Male sex (8 vs. 4 days, P < 0.005), more advanced cancer (2 vs. 11.5 days, P < 0.001), ADL dependent (RR 2.01, 95% CI 1.37–2.93), IADL dependent (RR 1.58, 95% CI 1.11–2.24), performance status abnormal (RR 1.64, 95% CI 1.06–2.56) Age, MMSE abnormal (RR 1.18, 95% CI 0.76–1.86), GDS depressed (RR 1.30, 95% CI 0.91–1.85), ASA abnormal (RR 0.85, 95% CI 0.60–1.20), Satariano’s index (RR 1.23, 95% CI 0.85–1.78)
Badgwell, 2013 [2] 111 NR NR Cancer stage (distant vs. localized/regional) (OR 0.37, 95% CI 0.15–0.91), weight loss ≥ 10% (OR 4.03, 95% CI 1.13–14.43), polypharmacy (OR 2.45, 95% CI 1.09–5.48) ASA score ≥ 2 (OR 1.02, 95% CI 0.39–2.69), ECOG performance status (OR 1.68, 95% CI 0.70–4.04)
Blakoe, 2015 [61] 79 NR NR NR Frailty
Clement, 2011 [24] 1343 NR NR Age (Pearson’s coefficient 0.21, P < 0.001) NR
Dasgupta, 2009 [7] 125 NR NR Age (P = 0.0074), Edmonton Frailty Scale score (P = 0.0042) NR
Gerude, 2014 [30] 67 7a 2–26b Smoking habit (OR 11.0, 95% CI 1.5–81.1), arm circumference ≤ 25 cm (OR 7.2, 95% CI 1.2–44.6), male sex (RR 2.15, 95% CI 1.10–4.18)a, IADL dependence (RR 1.97, 95% CI 1.07–3.61)a, underweight BMI (RR 2.23, 95% CI 1.19–4.55)a Age > 78 years (RR 0.98, 95% CI 0.56–1.74), alcoholism (RR 0.84, 95% CI 0.47–1.48), ADL dependence (RR 0.94, 95% CI 0.47–1.89), advanced cancer stage (RR 1.64, 95% CI 0.60–4.49), type 2 diabetes mellitus (RR 2.28, 95% CI 0.63–8.13), hypertension (RR 1.21, 95% CI 0.63–8.13), COPD (RR 0.62, 95% CI 0.33–1.16), overweight BMI (RR 1.37, 95% CI 0.55–3.41), type 1 diabetes mellitus (RR 1.02, 95% CI 0.53–1.96), Karnofsky index ≤ 80 (RR 1.69, 95% CI 0.97–2.94), albumin ≤ 4.3 mg/dL (RR 1.10, 95% CI 0.63–2.02)
Green, 2012 [39] 159 NR NR Frailty (9 ± 6 days vs. 6 ± 5 days, P = 0.004) NR
Huisman, 2014 [31] 280 NR NR TUG test > 20 s (OR 3.98, 95% CI 1.12–14.10), ASA score 2 (OR 0.23, 95% CI 0.05–0.99) ASA score > 2 (OR 0.37, 95% CI 0.08–1.68)
Kenig, 2015 [36] 75 12 3–42 Frailty + postoperative complications (10.4 vs. 20.3 days, P < 0.001) Frailty without postoperative complications (12.7 vs. 16.9 days, P = 0.19)
Kim, 2013 [51] 141 14 7–28 Cumulative number of impairments in CGA domains (P = 0.005) NR
Kim, 2016 [37] 197 NR NR Mobility assessment tool – short form (HR 0.81, 95% CI 0.68–0.96), ASA status ≥ 3 (HR 1.65, 95% CI 1.11–2.46), intermediate- or high-risk surgery (HR 2.83, 95% CI 1.84–4.36), hs-CRP (HR 1.40, 95% CI 1.02–1.92) Intermediately frail/frail (HR 1.13, 95% CI 0.79–1.60)
Kothari, 2011 [45] 60 NR NR Question 1 (6.55 ± 1.02 vs. 4.89 ± 0.84 days, P = 0.039), 9 (7.15 ± 1.16 vs. 5.04 ± 0.76 days, P = 0.01), and 10 (18.5 ± 9.50 vs. 5.04 ± 0.54 days, P = 0.031) of the NSI NHC NR
Lasithoiotakis, 2013 [35] 57 NR NR Frailty (OR 4.2, 95% CI 1.3–13.5) Age ≥ 75 years (OR 0.7, 95% CI 0.2–2.2), ASA score ≥ 3 (OR 5.6, 95% CI 0.8–35.8)
Makary, 2010 [29] 594 NR NR Frailty (IRR 1.69, 95% CI 1.28–2.23) NR
Papaioannou, 2005 [27] 47 NR NR NR General anesthesia (OR 2.50, 95% CI 0.74–8.46)
Reinohl, 2015 [59] 110 NR NR NR Atrial fibrillation (P = 0.171), EuroScore I (P = 0.067), EuroScore II (P = 0.210), STS score (P = 0.220)
Robinson, 2012 [25] 186 12a 12c Impaired cognition (15 ± 14 vs. 9 ± 9, P = 0.001) NR
Rogers, 1989 [58] 46 14.5a 4.5c Knee joint vs. hip (beta coefficient 4.3, standard error 1.3, P = 0.0021) Osteoarthritis vs. rheumatoid arthritis (beta coefficient 1.3, SE 1.4, P = 0.3676)
Schmidt, 2015 [60] 652 9 7–14 TUG test > 21 s (regression coefficient 2.91, 95% CI 0.24–5.58, P = 0.03), malnutrition on MNA (regression coefficient 6.99, 95% CI 3.02–10.96, P = 0.001) Above high school education (regression coefficient 0.18, 95% CI –0.79 to 1.15, P = 0.71), age (regression coefficient 0.08, 95% CI –0.23 to 0.19, P = 0.13), sex (regression coefficient 0.08, 95% CI –1.04 to 1.25, P = 0.86), tumor site (genitourinary vs. gastrointestinal) (regression coefficient –1.19, 95% CI –2.40 to 0.02, P = 0.05)
van Venrooij, 2009 [46] 100 NR NR NR Protein intake > 0.98 g/kg actual body weight (OR 0.857, 95% CI 0.376–1.956), protein intake > 0.98 g/kg ideal body weight (OR 0.857, 95% CI 0.376–1.956), energy intake > 21.3 kcal/kg actual body weight (OR 1.221, 95% CI 0.535–2.786), energy intake > 22.2 kcal/kg ideal body weight (OR 1.221, 95% CI 0.535–2.786)
Williams, 2013 [53] 148 NR NR NR Anxiety vs. none (OR 1.20, 95% CI 0.30–4.87)
  1. aMean
  2. bRange
  3. cStandard deviation
  4. ADLs activities of daily living, ASA American Society of Anesthesiologists, BMI body mass index, COPD chronic obstructive pulmonary disease, ECOG Eastern Cooperative Oncology Group, GDS geriatric depression scale, hs-CRP high sensitivity C-reactive protein, IADLs instrumental activities of daily living, MMSE Mini Mental State Exam, MNA Mini Nutritional Assessment, NSI NHC Nutrition Screening Initiative Nutritional Health Checklist, TUG timed up and go, CI confidence interval, HR hazard ratio, IQR interquartile range, NR not reported, OR odds ratio, RR relative risk