Correlation of ASA Grades of Patients with the Length of Hospital Stay After Emergency Laparotomy

Maria Zia, Syed Ali Haider, Muhammad Zubair, Saba Jamal, Syed Moiz Haseeb, Haseeb Munaf Seriwala

Abstract

Objective:

To determine the correlation of ASA grades of the patients with length of hospital stay (LOS) after laparotomy done in emergency.

Study design    

Cross-sectional observational study.

Place and duration of study:

Department of Surgery, Dr. Ruth K.M. Pfau Civil Hospital Karachi, from April 2025 to September 2025.

Methods:

Patients aged ≥18 years who underwent emergency laparotomy (EL) were included. Patients with history of malignancy, prior radiotherapy and previous laparotomy were excluded. Data on demographics, BMI, ASA grade, LOS, co-morbid conditions, duration of surgery, postoperative complications, postoperative mobility, oral intake status and ICU stay were recorded. Statistical analysis employed Chi-square/Fisher's exact tests for categorical variables, One-way ANOVA/Kruskal-Wallis for numerical variables, and binary logistic regression for confounders.

Results: A total of 80 patients were studied including fifty-three (66.3%) males. The mean age of the patients was 47.4±14.2 years. Majority (n=27 – 33.8%) were in ASA III category, and 8 (10%) ASA IV and V.  Mean operative time was 103±23 minutes and hospital stay 9±3 days.   Thirty-five (43.8%) patients required ICU admission and thirty-six (45%) developed complications. Higher ASA grade correlated with older age, lower BMI, more comorbid conditions, longer duration of surgery, greater ICU use, delayed oral intake / mobility, more complications, and longer stay (p < 0.0001). On multivariate analysis, only postoperative complications independently predicted prolonged hospital stay (≥ 9 days - p=0.022).

Conclusion:

Higher ASA grade correlated with worse perioperative outcomes, but postoperative complications emerged as the only independent predictor of prolonged hospital stay after emergency laparotomy.

Key words:

Laparotomy, ASA classification, Hospital stay, Postoperative complications.