P I Tartter1. 1. Department of Surgery, Mount Sinai Medical Center, New York, 10029, USA.
Abstract
OBJECTIVE: The author's objective was to determine whether the length of postoperative stay for patients after colorectal cancer surgery is associated with prognosis. SUMMARY BACKGROUND DATA: Financial pressure to reduce hospital costs has caused physicians to reduce hospital stays by changes in patient care, which reduce hospital stay but may compromise long-term results. METHODS: Using multivariate analysis, the author examined the relationship between postoperative stay and prognosis in a consecutive series of 341 prospectively studied patients with colorectal cancer undergoing potentially curative surgery. RESULTS: In multivariate analysis, patients staying beyond the median of 11 days had more complications (p=0.000), more left hemicolectomies and procedures with colostomies (p=0.000), were older (p=0.002), and lost more blood (p=0.012) than patients staying less than the median. Disease-free survival was significantly and independently related to Dukes' stage (p=0.000), postoperative stay (p=0.001), and blood transfusion (p=0.011). The mean postoperative stay for the 98 patients who later developed recurrence was 15 days compared to 12 days for the 243 patients who remained disease free (p=0.0008). Cumulative disease-free survival of the 142 patients who stayed more than the median of 11 days was 60% compared to 77% for the 199 patients with shorter stays (p=0.000). CONCLUSIONS: These data indicate that shorter hospital stays do not compromise disease-free survival of patients with colorectal cancer.
OBJECTIVE: The author's objective was to determine whether the length of postoperative stay for patients after colorectal cancer surgery is associated with prognosis. SUMMARY BACKGROUND DATA: Financial pressure to reduce hospital costs has caused physicians to reduce hospital stays by changes in patient care, which reduce hospital stay but may compromise long-term results. METHODS: Using multivariate analysis, the author examined the relationship between postoperative stay and prognosis in a consecutive series of 341 prospectively studied patients with colorectal cancer undergoing potentially curative surgery. RESULTS: In multivariate analysis, patients staying beyond the median of 11 days had more complications (p=0.000), more left hemicolectomies and procedures with colostomies (p=0.000), were older (p=0.002), and lost more blood (p=0.012) than patients staying less than the median. Disease-free survival was significantly and independently related to Dukes' stage (p=0.000), postoperative stay (p=0.001), and blood transfusion (p=0.011). The mean postoperative stay for the 98 patients who later developed recurrence was 15 days compared to 12 days for the 243 patients who remained disease free (p=0.0008). Cumulative disease-free survival of the 142 patients who stayed more than the median of 11 days was 60% compared to 77% for the 199 patients with shorter stays (p=0.000). CONCLUSIONS: These data indicate that shorter hospital stays do not compromise disease-free survival of patients with colorectal cancer.
Authors: Thomas Anthony; Linda S Hynan; Douglas Rosen; Lawrence Kim; Fiemu Nwariaku; Charlene Jones; George Sarosi Journal: Ann Surg Date: 2003-11 Impact factor: 12.969