Miren Orive1,2, Urko Aguirre3,4, Nerea Gonzalez3,4, Santiago Lázaro5, Maximino Redondo4,6, Marisa Bare4,7, Rocío Anula8, Eduardo Briones9, Antonio Escobar4,10, Cristina Sarasqueta4,11, Susana Garcia-Gutierrez3,4, José M Quintana3,4. 1. Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain. miren.orivecalzada@osakidetza.net. 2. Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain. miren.orivecalzada@osakidetza.net. 3. Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain. 4. Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain. 5. General Surgery Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain. 6. Research Unit, Hospital Costa del Sol, Málaga, Spain. 7. Clinical Epidemiology Unit, Corporacio Parc Tauli, Barcelona, Spain. 8. Colorectal Unit, Hospital Clínico San Carlos, Madrid, Spain. 9. UDG Public Health. Distrito AP Sevilla, Sevilla, Spain. 10. Research Unit, Basurto University Hospital, Basurto, Bilbao, Bizkaia, Spain. 11. Research Unit, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain.
Abstract
PURPOSE: To identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in patients undergoing resection for colorectal cancer. METHODS: This prospective cohort study included 1955 patients admitted to 22 hospitals for primary resection of colorectal cancer. Multivariate analyses were used to identify and validate risk factors, randomizing patients into a derivation and a validation cohort. Multiple correspondence and cluster analysis were performed to identify clinical subtypes based on LOS. RESULTS: The strongest independent predictors of prolonged LOS were postoperative reintervention, surgical site infection, open surgery, and distant metastasis. The multiple correspondence and cluster analysis provided three groups of patients in relation to prolonged LOS: patients with the longest LOS included the highest percentage of patients with open surgery, distant metastasis, deep surgical site infections, emergency admissions, additional diagnostic factors, and highly contaminated surgical sites. Patients with prolonged LOS (> 14 days) were more likely to develop adverse outcomes within 30 days after discharge. CONCLUSIONS: Patients undergoing resection of colorectal cancer cluster into different groups based on LOS of the index admission. Those with prolonged LOS were more likely to develop adverse outcomes within 30 days after discharge. Some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes. TRIAL REGISTRATION: NCT02488161.
PURPOSE: To identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in patients undergoing resection for colorectal cancer. METHODS: This prospective cohort study included 1955 patients admitted to 22 hospitals for primary resection of colorectal cancer. Multivariate analyses were used to identify and validate risk factors, randomizing patients into a derivation and a validation cohort. Multiple correspondence and cluster analysis were performed to identify clinical subtypes based on LOS. RESULTS: The strongest independent predictors of prolonged LOS were postoperative reintervention, surgical site infection, open surgery, and distant metastasis. The multiple correspondence and cluster analysis provided three groups of patients in relation to prolonged LOS: patients with the longest LOS included the highest percentage of patients with open surgery, distant metastasis, deep surgical site infections, emergency admissions, additional diagnostic factors, and highly contaminated surgical sites. Patients with prolonged LOS (> 14 days) were more likely to develop adverse outcomes within 30 days after discharge. CONCLUSIONS:Patients undergoing resection of colorectal cancer cluster into different groups based on LOS of the index admission. Those with prolonged LOS were more likely to develop adverse outcomes within 30 days after discharge. Some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes. TRIAL REGISTRATION: NCT02488161.
Authors: Eric B Schneider; Omar Hyder; Benjamin S Brooke; Jonathan Efron; John L Cameron; Barish H Edil; Richard D Schulick; Michael A Choti; Christopher L Wolfgang; Timothy M Pawlik Journal: J Am Coll Surg Date: 2012-01-29 Impact factor: 6.113
Authors: Ravi P Kiran; Conor P Delaney; Anthony J Senagore; Malcolm Steel; Thomas Garafalo; Victor W Fazio Journal: J Am Coll Surg Date: 2004-06 Impact factor: 6.113