A Step Beyond Mortality: Identifying Factors of Prolonged Hospital Stay for Emergency General Surgery Conditions in a Low- and Middle-Income Country

Introduction: While various factors leading to prolonged length of stay (LOS) have been identified for emergency general surgery (EGS), there is limited literature on specific factors for individual emergent specialties. This study aimed to identify patient factors and in-hospital complications associated with prolonged LOS for gastrointestinal (GI) and non-GI-related EGS presentations in a low-resource setting. Methods: Data from 2010 to 2019 were retrieved from one of the largest tertiary care centers in Pakistan. We included adult patients (≥18 y) with index admissions for primary EGS conditions mapped to surgical areas defined by the American Association for Surgery of Trauma. Multivariable linear regression models were created to ascertain factors associated with prolonged LOS for 11 American Association for Surgery of Trauma -defined surgical areas. Results: The mean age of 31,499 patients was 48.87 ± 16.82 y, where 23,198 (73.65%) patients underwent surgery. Undergoing emergency surgery was independently associated with increased LOS for all surgical areas (all P values < 0.05), except for hepatic-pancreatic-biliary. Sepsis and septic shock were the most common complications for both operated and nonoperated patients and were significantly associated with increased LOS for most of the surgical areas. For non-GI-related surgical areas, uninsured patients had significantly greater LOS for soft tissue conditions only (β: 0.85; 95% CI: 0.49, 1.21). Conclusions: Different specialties have different drivers for prolonged hospital stay in EGS. This underscores the need to identify and address patient factors and in-hospital complications early on, according to individual specialties. Specific strategies catered to these factors will optimize preoperative care and reduce complications, ultimately decreasing patients’ stay after an EGS presentation.