Michal Radomski1, Mazen Zenati2, Stephanie Novak3, Vernissia Tam4, Jennifer Steve5, David L Bartlett6, Amer H Zureikat7, Herbert J Zeh8, Melissa E Hogg9. 1. Department of Surgery, George Washington University, 2150 Pennsylvania Ave. NW, Suite 6B, Washington, DC 20037, United States. Electronic address: michal.Radomski.1@gmail.com. 2. Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: zenatims@upmc.edu. 3. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: novaksm@upmc.edu. 4. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: tamvw@upmc.edu. 5. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: jennifer.steve@ert.com. 6. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: bartdl@upmc.edu. 7. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: zureikatah@upmc.edu. 8. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: zehxhx@upmc.edu. 9. Division of Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: hoggme@upmc.edu.
Abstract
BACKGROUND: Complex surgeries such as a pancreatoduodenectomy (PD) traditionally have long hospital stays (LOS). METHODS: Patients who underwent elective PD at our institution from 8/2011-6/2015 were retrospectively examined. Interquartile ranges were calculated from LOS. Patient were compared between the highest quartile and the remainder of the cohort. RESULTS: 492 patients had a median LOS of 9 days, with 106 (22%) admitted for >14 days. Characteristics associated with prolong hospitalization include age (p = 0.004) and preoperative albumin <3.5 (p = 0.007). Significant intra-operative measures associated with prolonged LOS were blood loss (EBL, p = 0.004) and increased operative time (p = 0.008). Any complication extended hospitalizations (p < 0.001). Patients in the top quartile were less likely to be discharged home (p < 0.0001) and more likely to be readmitted (p < 0.0001). CONCLUSION: Older patients with hypoalbuminemia are at higher risk of prolonged LOS following PD as well as high EBL, operative time, and surgical complications. Focused efforts to counsel and optimize patients pre-operatively and minimize intra-operative complications may shorten hospital stays.
BACKGROUND: Complex surgeries such as a pancreatoduodenectomy (PD) traditionally have long hospital stays (LOS). METHODS:Patients who underwent elective PD at our institution from 8/2011-6/2015 were retrospectively examined. Interquartile ranges were calculated from LOS. Patient were compared between the highest quartile and the remainder of the cohort. RESULTS: 492 patients had a median LOS of 9 days, with 106 (22%) admitted for >14 days. Characteristics associated with prolong hospitalization include age (p = 0.004) and preoperative albumin <3.5 (p = 0.007). Significant intra-operative measures associated with prolonged LOS were blood loss (EBL, p = 0.004) and increased operative time (p = 0.008). Any complication extended hospitalizations (p < 0.001). Patients in the top quartile were less likely to be discharged home (p < 0.0001) and more likely to be readmitted (p < 0.0001). CONCLUSION: Older patients with hypoalbuminemia are at higher risk of prolonged LOS following PD as well as high EBL, operative time, and surgical complications. Focused efforts to counsel and optimize patients pre-operatively and minimize intra-operative complications may shorten hospital stays.