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Risk factors affecting hospital stay among patients undergoing colon cancer surgery: a prospective cohort study

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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

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Acknowledgments

The authors are grateful for the patients who voluntarily took part in this study. We also thank the doctors and the interviewers from the participating hospitals (Hospital de Antequera, Hospital Costa del Sol, Hospital Universitario de Valme, Hospital Universitario Virgen del Rocío, Hospital Universitario Virgen de las Nieves, Hospital Universitario de Canarias, Corporació Sanitaria Parc Taulí, Althaia, Hospital del Mar, Hospital Clínico San Carlos, Hospital Universitario La Paz, Hospital Infanta Sofía, Hospital Universitario Fundación Alcorcón, Hospital Galdakao-Usansolo, Hospital Universitario Araba, Hospital Universitario Basurto, Hospital Universitario Cruces, Hospital Hospitalario Donostia, Hospital Bidasoa, Hospital de Mendaro, Hospital de Zumarraga, and Hospital Universitario Doctor Peset), for their invaluable collaboration in patient recruitment, and the Research Committees of the participating hospitals.

Source of funding

This work was supported in part by grants from the Fondo de Investigación Sanitaria (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90397, PI09/90453, PI09/90441); Department of Health of the Basque Country (2010111098); KRONIKGUNE—Centro de Investigación en Cronicidad (KRONIK 11/006); and the European Regional Development Fund. These institutions had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain

    Miren Orive, Urko Aguirre, Nerea Gonzalez, Susana Garcia-Gutierrez & José M. Quintana

  2. Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain

    Miren Orive, Urko Aguirre, Nerea Gonzalez, Maximino Redondo, Marisa Bare, Antonio Escobar, Cristina Sarasqueta, Susana Garcia-Gutierrez & José M. Quintana

  3. General Surgery Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain

    Santiago Lázaro

  4. Research Unit, Hospital Costa del Sol, Málaga, Spain

    Maximino Redondo

  5. Clinical Epidemiology Unit, Corporacio Parc Tauli, Barcelona, Spain

    Marisa Bare

  6. Colorectal Unit, Hospital Clínico San Carlos, Madrid, Spain

    Rocío Anula

  7. UDG Public Health. Distrito AP Sevilla, Sevilla, Spain

    Eduardo Briones

  8. Research Unit, Basurto University Hospital, Basurto, Bilbao, Bizkaia, Spain

    Antonio Escobar

  9. Research Unit, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain

    Cristina Sarasqueta

Authors
  1. Miren Orive
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  2. Urko Aguirre
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  3. Nerea Gonzalez
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  4. Santiago Lázaro
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  6. Marisa Bare
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  7. Rocío Anula
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  8. Eduardo Briones
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  9. Antonio Escobar
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  10. Cristina Sarasqueta
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  11. Susana Garcia-Gutierrez
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  12. José M. Quintana
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Consortia

for the REDISSEC-CARESS/CCR group

  • Jose María Quintana López
  • , Marisa Baré Mañas
  • , Maximino Redondo Bautista
  • , Eduardo Briones Pérez de la Blanca
  • , Nerea Fernández de Larrea Baz
  • , Cristina Sarasqueta Eizaguirre
  • , Antonio Escobar Martínez
  • , Francisco Rivas Ruiz
  • , Maria M. Morales-Suárez-Varela
  • , Juan Antonio Blasco Amaro
  • , Isabel del Cura González
  • , Inmaculada Arostegui Madariaga
  • , Amaia Bilbao González
  • , Nerea González Hernández
  • , Susana García-Gutiérrez
  • , Iratxe Lafuente Guerrero
  • , Urko Aguirre Larracoechea
  • , Miren Orive Calzada
  • , Josune Martin Corral
  • , Ane Antón-Ladislao
  • , Núria Torà
  • , Marina Pont
  • , María Purificación Martínez del Prado
  • , Alberto Loizate Totorikaguena
  • , Ignacio Zabalza Estévez
  • , José Errasti Alustiza
  • , Antonio Z. Gimeno García
  • , Santiago Lázaro Aramburu
  • , Mercè Comas Serrano
  • , Jose María Enríquez Navascues
  • , Carlos Placer Galán
  • , Amaia Perales
  • , Iñaki Urkidi Valmaña
  • , Jose María Erro Azkárate
  • , Enrique Cormenzana Lizarribar
  • , Adelaida Lacasta Muñoa
  • , Pep Piera Pibernat
  • , Elena Campano Cuevas
  • , Ana Isabel Sotelo Gómez
  • , Segundo Gómez-Abril
  • , F. Medina-Cano
  • , Julia Alcaide
  • , Arturo Del Rey-Moreno
  • , Manuel Jesús Alcántara
  • , Rafael Campo
  • , Alex Casalots
  • , Carles Pericay
  • , Maria José Gil
  • , Miquel Pera
  • , Pablo Collera
  • , Josep Alfons Espinàs
  • , Mercedes Martínez
  • , Mireia Espallargues
  • , Caridad Almazán
  • , Paula Dujovne Lindenbaum
  • , José María Fernández-Cebrián
  • , Rocío Anula Fernández
  • , Julio Ángel Mayol Martínez
  • , Ramón Cantero Cid
  • , Héctor Guadalajara Labajo
  • , María Heras Garceau
  • , Damián García Olmo
  • , Mariel Morey Montalvo
  •  & Javier Mar

Corresponding author

Correspondence to Miren Orive.

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Appendix

Appendix

The REDISSEC CARESS-CCR (Results and Health Services Research in Colorectal Cancer)- group

Jose María Quintana López1, Marisa Baré Mañas2, Maximino Redondo Bautista3, Eduardo Briones Pérez de la Blanca4, Nerea Fernández de Larrea Baz5, Cristina Sarasqueta Eizaguirre6, Antonio Escobar Martínez7, Francisco Rivas Ruiz8, Maria M. Morales-Suárez-Varela9, Juan Antonio Blasco Amaro10, Isabel del Cura González11, Inmaculada Arostegui Madariaga12, Amaia Bilbao González7, Nerea González Hernández1, Susana García-Gutiérrez1, Iratxe Lafuente Guerrero1, Urko Aguirre Larracoechea1, Miren Orive Calzada1, Josune Martin Corral1, Ane Antón-Ladislao1, Núria Torà13, Marina Pont13, María Purificación Martínez del Prado14, Alberto Loizate Totorikaguena15, Ignacio Zabalza Estévez16, José Errasti Alustiza17, Antonio Z Gimeno García18, Santiago Lázaro Aramburu19, Mercè Comas Serrano20, Jose María Enríquez Navascues21, Carlos Placer Galán21, Amaia Perales22, Iñaki Urkidi Valmaña23, Jose María Erro Azkárate24, Enrique Cormenzana Lizarribar25, Adelaida Lacasta Muñoa26, Pep Piera Pibernat26, Elena Campano Cuevas27, Ana Isabel Sotelo Gómez28, Segundo Gómez-Abril29, F. Medina-Cano30, Julia Alcaide31, Arturo Del Rey-Moreno32, Manuel Jesús Alcántara33, Rafael Campo34, Alex Casalots35, Carles Pericay36, Maria José Gil37, Miquel Pera37, Pablo Collera38, Josep Alfons Espinàs39, Mercedes Martínez40, Mireia Espallargues41, Caridad Almazán42, Paula Dujovne Lindenbaum43, José María Fernández-Cebrián43, Rocío Anula Fernández44, Julio Ángel Mayol Martínez44, Ramón Cantero Cid45, Héctor Guadalajara Labajo46, María Heras Garceau46, Damián García Olmo46, Mariel Morey Montalvo47,Javier Mar 48.

1Unidad de Investigación. Hospital Galdakao-Usansolo, Galdakao-Bizkaia / Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC.

2Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell / Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC.

3Servicio de Laboratorio. Hospital Costa del Sol, Málaga / REDISSEC.

4Unidad de Epidemiología. Distrito Sevilla, Servicio Andaluz de Salud.

5Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid /CIBER de Epidemiología y Salud Pública.

6Unidad de Investigación. Hospital Universitario Donostia /Instituto de Investigación Sanitaria Biodonostia, Donostia – REDISSEC.

7Unidad de Investigación. Hospital Universitario Basurto, Bilbao / REDISSEC.

8Servicio de Epidemiología. Hospital Costa del Sol, Málaga – REDISSEC.

9Department of Preventive Medicine and Public Health, Univesity of Valencia / CIBER de Epidemiología y Salud Pública (CIBERESP) / CSISP-FISABIO, Valencia.

10Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid.

11Unidad Apoyo a Docencia-Investigación. Dirección Técnica Docencia e Investigación. Gerencia Adjunta Planificación. Gerencia de Atención Primaria de la Consejería de Sanidad de la Comunidad Autónoma de Madrid.

12Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPV- REDISSEC.

13Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell / REDISSEC.

14Servicio de Oncología. Hospital Universitario Basurto, Bilbao.

15Servicio de Cirugía General. Hospital Universitario Basurto, Bilbao.

16Servicio de Anatomía Patológica. Hospital Galdakao-Usansolo, Galdakao.

17Servicio de Cirugía General. Hospital Universitario Araba, Vitoria-Gasteiz.

18Servicio de Gastroenterología. Hospital Universitario de Canarias, La Laguna.

19Servicio de Cirugía General. Hospital Galdakao-Usansolo, Galdakao.

20IMAS-Hospital del Mar, Barcelona.

21Servicio de Cirugía General y Digestiva. Hospital Universitario Donostia.

22Instituto de Investigación Sanitaria Biodonostia, Donostia.

23Servicio de Cirugía General y Digestiva. Hospital de Mendaro.

24Servicio de Cirugía General y Digestiva. Hospital de Zumárraga.

25Servicio de Cirugía General y Digestiva. Hospital del Bidasoa.

26Servicio de Oncología Médica. Hospital Universitario Donostia.

27Instituto de Biomedicina de Sevilla. Hospital Universitario Virgen del Rocío, Sevilla.

28Servicio de Cirugía. Hospital Universitario Virgen de Valme, Sevilla.

29Servicio de Cirugía General y Aparato Digestivo. Hospital Dr. Pesset, Valencia.

30Servicio de Cirugía General y Aparato Digestivo. Agencia Sanitaria Costa del Sol, Marbella.

31Servicio de Oncología Médica. Agencia Sanitaria Costa del Sol, Marbella.

32Servicio de Cirugía. Hospital de Antequera.

33Coloproctology Unit, General and Digestive Surgery Service, Corporació Sanitaria Parc Taulí, Sabadell.

34Digestive Diseases Department, Corporació Sanitaria Parc Taulí, Sabadell.

35Pathology Service, Corporació Sanitaria Parc Taulí, Sabadell.

36Medical Oncology Department, Corporació Sanitaria Parc Taulí, Sabadell / REDISSEC.

37General and Digestive Surgery Service, Parc de Salut Mar, Barcelona.

38General and Digestive Surgery Service, Althaia- Xarxa Assistencial Universitaria, Manresa.

39Catalonian Cancer Strategy Unit, Department of Health, Institut Català d’Oncología.

40Medical Oncology Department, Institut Català d’Oncología.

41Agency for Health Quality and Assessment of Catalonia –AquAS- and REDISSEC.

42Agency for Health Quality and Assessment of Catalonia –AQuAS-, CIBER de Epidemiología y Salud Pública –CIBERESP.

43Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid.

44Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid.

45Servicio Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid.

46Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid.

47REDISSEC. Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Madrid.

48 REDISSEC. Unidad de Gestión Sanitaria. Hospital del Alto Deba. Mondragon-Arrasate. Spain.

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Orive, M., Aguirre, U., Gonzalez, N. et al. Risk factors affecting hospital stay among patients undergoing colon cancer surgery: a prospective cohort study. Support Care Cancer 27, 4133–4144 (2019). https://doi.org/10.1007/s00520-019-04683-7

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