{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T09:09:55Z","timestamp":1789808995352,"version":"4.0.1"},"reference-count":65,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hosp Pharm"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Prolonged length of stay (LOS) is a key indicator of surgical quality, efficiency of care, and resource utilization. This study aimed to identify predictors of prolonged LOS and evaluate perioperative antibiotic use patterns among general surgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective observational study was conducted at a Malaysian general hospital between January and October 2023. Adult patients undergoing elective or emergency general surgical procedures were consecutively enrolled. Prolonged LOS was defined as total hospitalization exceeding the cohort median (&gt;3 days). Multivariate logistic regression was used to identify independent predictors, with full model diagnostics evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 405 patients, 35.8% experienced prolonged LOS. Gastrointestinal (GI) surgery was the strongest independent predictor of prolonged stay (adjusted odds ratio [AOR] 85.76, 95% CI: 10.94-672.34). Other independent predictors included C-reactive protein (CRP) testing (AOR 5.03, 95% CI: 1.99-12.69), positive culture and sensitivity (C&amp;S) results (AOR 2.52, 95% CI: 1.22-5.23), longer operative duration (AOR 1.02 per minute, 95% CI: 1.01-1.03), and greater intraoperative blood loss (IBL) (AOR 1.00 per mL, 95% CI: 1.00-1.01). In contrast, intraoperative cefazolin use (AOR 0.08, 95% CI: 0.02-0.39) and absence of postoperative antibiotics (AOR 0.41, 95% CI: 0.21-0.79) were favourable markers associated with shorter hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Prolonged LOS in general surgery is primarily driven by disease severity and surgical complexity. Adherence to guideline-recommended surgical antimicrobial prophylaxis and the absence of need for postoperative antibiotics are favourable markers of uncomplicated recovery, supporting health system efficiency and antimicrobial stewardship goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00185787261485529","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:56:41Z","timestamp":1789621001000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Prolonged Length of Stay and Perioperative Antibiotic Use Patterns in General Surgery: A Single-Centre Observational Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0862-607X","authenticated-orcid":false,"given":"Jian Wan","family":"Lee","sequence":"first","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Gie","family":"Ong","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubiah binti","family":"Mohd Dayaon","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarmukh Singh","family":"Charanjit Singh","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei Shi","family":"Tan","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Amalina binti","family":"Abd Halim","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing Tong","family":"Tai","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Firdauss bin","family":"Osman","sequence":"additional","affiliation":[{"name":"Hospital Tengku Permaisuri Norashikin, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195901"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199908000-00016"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-022-01886-4"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61050922"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.47009\/jamp.2025.7.1.192"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1590\/S2237-93632013000100005"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2025.e43370"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2018.03.022"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.01.032"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.837545"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.7150\/jca.65817"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3892\/br.2023.1710"},{"key":"e_1_3_2_14_2","volume-title":"Global Guidelines for the Prevention of Surgical Site Infection","author":"WHO","year":"2018","unstructured":"WHO. Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization; 2018."},{"key":"e_1_3_2_15_2","volume-title":"National Antimicrobial Guideline 2024","author":"Ministry of Health Malaysia","year":"2024","unstructured":"Ministry of Health Malaysia. National Antimicrobial Guideline 2024. Pharmaceutical Services Division, MOH Malaysia. 2024."},{"key":"e_1_3_2_16_2","volume-title":"Surgical Site Infections: Prevention and Treatment NICE Guideline","author":"NICE","year":"2019","unstructured":"NICE. Surgical Site Infections: Prevention and Treatment NICE Guideline. NICE; 2019."},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000001882"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.64898\/2026.02.12.26346187"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2817-8"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.12.042"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/1754-9493-4-5"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0243995"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/6417240"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.5152\/UCD.2015.2969"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14062099"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.50942"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-021-03854-5\/Published"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-021-00387-8"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5659-4"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10487"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-015-2205-y"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-023-05798-3"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05841-5"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2017.089"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2009.09.034"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp120568"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sopen.2022.05.006"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-023-02210-4"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0000000000001234"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0243575"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-51172-2"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-023-02225-9"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-022-00431-1"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1177\/2050640616661931"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-012-1972-9"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-010-1344-z"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9008"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-016-0081-6"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cireng.2023.11.022"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.14744\/scie.2024.47855"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-022-00406-2"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu296"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-018-0219-9"},{"key":"e_1_3_2_55_2","volume-title":"Skin and Soft Tissue Infections","author":"Leong C","year":"2021","unstructured":"Leong C, Gouliouris T. Skin and Soft Tissue Infections. Springer; 2021."},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1186\/1749-7922-9-57"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2022.011"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2021.256"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-021-01456-0"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2024.05.001"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.47717\/turkjsurg.2021.4961"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.4236\/ojepi.2013.33020"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-5-585"},{"key":"e_1_3_2_64_2","volume-title":"Laparoscopic Total Extraperitoneal Approach Versus Open Lichtenstein Repair of Primary Unilateral Uncomplicated Inguinal Hernia: A Single Centre Experience in Malaysia","author":"Voon Yen F","year":"2017","unstructured":"Voon Yen F, Sani I, Nizam M, Hashim M, Ramely R, Dzulkarnaen Zakaria A. Laparoscopic Total Extraperitoneal Approach Versus Open Lichtenstein Repair of Primary Unilateral Uncomplicated Inguinal Hernia: A Single Centre Experience in Malaysia. Doctoral dissertation. Universiti Sains Malaysia; 2017."},{"key":"e_1_3_2_65_2","first-page":"58","article-title":"Risk factor for inappropriate use of prophylactic antibiotics in inguinal hernia repair surgery","volume":"79","author":"Hendrawan F","year":"2024","unstructured":"Hendrawan F, Aris Agung Nugrahningsih D, Purnomo E, Anugrah Azdy N. Risk factor for inappropriate use of prophylactic antibiotics in inguinal hernia repair surgery. Med J Malays. 2024;79(Suppl. 4):58-62.","journal-title":"Med J Malays"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1015-9584(09)60057-9"}],"container-title":["Hospital Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00185787261485529","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00185787261485529","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00185787261485529","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:20:07Z","timestamp":1789806007000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00185787261485529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":65,"alternative-id":["10.1177\/00185787261485529"],"URL":"https:\/\/doi.org\/10.1177\/00185787261485529","relation":{},"ISSN":["0018-5787","1945-1253"],"issn-type":[{"value":"0018-5787","type":"print"},{"value":"1945-1253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"00185787261485529"}}