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Early Red Flags Associated with Delayed Discharge in Patients Undergoing Gastrectomy: Analysis of Perioperative Variables and ERAS Protocol Items

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Abstract

Background

Enhanced Recovery After Surgery (ERAS) perioperative pathways are safe and effective for patients undergoing gastrectomy. However, adherence to these protocols varies and is generally underreported. This retrospective study aimed to assess whether perioperative variables or deviation from ERAS items is associated with delayed discharge after gastrectomy.

Methods

All patients undergoing gastrectomy at our institution were managed with a standardised perioperative pathway according to ERAS principles. The target length of stay was set as the ninth post-operative day (POD). All significant variables were derived from a bivariate analysis and were entered into a logistic regression to confirm their statistical value.

Results

The study included 180 patients. Multivariate regression analysis revealed that incomplete immunonutrition, failure to extubate the patient at the end of surgery, intraoperative crystalloids >2150 ml and blood transfusion >268 ml, surgery duration >195 min, and failure to mobilise patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (p < 0.001) and correctly classified 73.6% of cases. Sensitivity and specificity were 74.1% and 73.2%, respectively.

Conclusions

These results seem clinically significant and consistent with those of previous studies. The reported perioperative variables showed a strong relationship with the length of hospital stay.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy

    Paolo Parise, Lorenzo Cinelli, Carlo Ferrari, Andrea Cossu, Francesco Puccetti, Leonardo Garutti, Ugo Elmore & Riccardo Rosati

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  1. Paolo Parise
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  2. Lorenzo Cinelli
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  3. Carlo Ferrari
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  4. Andrea Cossu
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  5. Francesco Puccetti
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  6. Leonardo Garutti
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Correspondence to Lorenzo Cinelli.

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The authors declare that they have no conflict of interest.

Ethical standards

This study was conducted according to the Declaration of Helsinki, and all patients provided written informed consent.

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Informed consent was obtained from all individual participants included in the study.

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Parise, P., Cinelli, L., Ferrari, C. et al. Early Red Flags Associated with Delayed Discharge in Patients Undergoing Gastrectomy: Analysis of Perioperative Variables and ERAS Protocol Items. World J Surg 44, 223–231 (2020). https://doi.org/10.1007/s00268-019-05223-4

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  • DOI: https://doi.org/10.1007/s00268-019-05223-4

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