A prospective study of preoperative risk factors associated with extended length of stay in patients attending a pre-operative clinic in South Africa

Preoperative assessment clinics play a critical role in identifying,
evaluating, and mitigating perioperative risks. Despite global data
highlighting the importance of preoperative risk factors on surgical
outcomes, there remains limited information on their impact on
postoperative length of stay in South African contexts. This
study aimed to describe the demographic and clinical profiles of patients
referred to a preoperative clinic in Johannesburg, South Africa, and to
examine factors associated with postoperative length of stay
(LOS). This was a prospective cohort study conducted between 2021
and 2022 at a private clinic. Patients aged ≥18 years undergoing
non-cardiac surgery were included. Data on demographics, comorbidities,
surgical procedures, and clinical outcomes were collected. Statistical
analysis was performed to assess relationships between preoperative risk
factors, including ASA grading, Revised Cardiac Risk Index (RCRI), eGFR,
Diabetes Mellitus, age, obesity, and LOS. A total of 214 patients
were assessed, of which 75.7% were female, with a median age of 62.5
years. Common comorbidities included hypertension (59.3%) and obesity
(55%). The median LOS was 3.5 days, with 47.2% of patients staying more
than 3 days postoperatively. Knee (33.2%) and hip surgeries (21%) were the
most common procedures. A significant association was found between longer
LOS and RCRI score ≥1 (p=0.007), as well as renal dysfunction in knee
surgery patients (p=0.027) and age in patients undergoing hip surgery
(p=0.049). There was no significant association between ASA grade,
presence of diabetes mellitus, eGFR, age, or obesity. Increased RCRI
scores, renal dysfunction, and age were associated with prolonged hospital
stays. Findings highlight the need for targeted interventions in
preoperative care to reduce LOS, particularly for high-risk patients.
Further research is needed to validate these results across broader
healthcare settings and to establish appropriate protocols for South
African patients undergoing pre-operative assessment.