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Identification of Candidates for Early Discharge After Gastrectomy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to analyze clinical and laboratory variables associated with complications after gastrectomy for gastric cancer to predict candidates for successful early discharge.

Methods

Consecutive patients undergoing gastrectomy at Seoul National University Hospital from January through December 2013 were identified from a prospective complications database. Clinicopathologic and postoperative laboratory parameters were analyzed to determine variables associated with complications. An additional validation study was performed from March through May 2014.

Results

Overall, complications occurred in 180/855 patients (21.1 %). Age >68 years (odds ratio [OR] 1.64), use of an open approach (OR 1.9), and use of combined resection (OR 1.67) were significant independent risk factors for complications (p < 0.05). The postoperative day (POD) 5 to preoperative white blood cell count (WBC) ratio (risk ratio [RR] 2.01), C-reactive protein (CRP) level on POD 5 (RR 1.1), and maximum body temperature on POD 4 (RR 2.36) independently predicted complications in a multivariate analysis (p < 0.05). After establishing an early discharge profile (EDP) based on these six variables, 152/855 patients (17.8 %) were predicted to have an uncomplicated course. Of these, 8/152 (5.3 %) experienced complications. In a validation study of 217 patients, 43/217 (19.8 %) were candidates for early discharge on POD 5, and 3 (7.0 %) had a false-positive EDP.

Conclusions

Patients younger than 68 years of age who underwent laparoscopic gastrectomy without combined resection might be candidates for early discharge on POD 5 if the POD 5 to preoperative WBC ratio is ≤1.2, POD 5 CRP level is ≤5.38 g/mL, and POD 4 body temperature is ≤37.4 °C.

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Funding

This study was supported by a grant from the National R & D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1320270).

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Author notes

    Authors and Affiliations

    1. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

      Ji-Ho Park MD, Young-Gil Son MD, PhD, Tae-Han Kim MD, PhD, Yeon-Ju Huh MD, Jun-Young Yang MD, Yong-Joon Suh MD, Yun-Suhk Suh MD, Seong-Ho Kong MD, PhD, Hyuk-Joon Lee MD, PhD & Han-Kwang Yang MD, PhD

    2. Department of Surgery, Gyeongsang National University Hospital, Jinju, South Korea

      Ji-Ho Park MD

    3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

      Hyuk-Joon Lee MD, PhD & Han-Kwang Yang MD, PhD

    Authors
    1. Ji-Ho Park MD
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    2. Young-Gil Son MD, PhD
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    3. Tae-Han Kim MD, PhD
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    4. Yeon-Ju Huh MD
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    5. Jun-Young Yang MD
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    6. Yong-Joon Suh MD
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    Corresponding author

    Correspondence to Han-Kwang Yang MD, PhD.

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    Disclosure

    Ji-Ho Park, Young-Gil Son, Tae-Han Kim, Yeon-Ju Huh, Jun-Young Yang, Yong-Joon Suh, Yun-Suhk Suh, Seong-Ho Kong, Hyuk-Joon Lee, and Han-Kwang Yang declare no potential conflicts of interest.

    Additional information

    Ji-Ho Park and Young-Gil Son have contributed equally to this study.

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    Supplementary material 1 (DOCX 115 kb)

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    Cite this article

    Park, JH., Son, YG., Kim, TH. et al. Identification of Candidates for Early Discharge After Gastrectomy. Ann Surg Oncol 24, 159–166 (2017). https://doi.org/10.1245/s10434-016-5447-1

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    • DOI: https://doi.org/10.1245/s10434-016-5447-1

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