Abstract
Background
There is increasing pressure to reduce the length of stay in hospital (LOS) after colorectal surgery. The aim of this study was to identify factors that prolong LOS after colorectal surgery in a population of veterans.
Methods
Retrospective analysis was performed of all patients undergoing colorectal resection for a neoplasm at a single Veterans Affairs (VA) hospital (2002–2007). Data collected included demographics, co-morbidities, operative management, postoperative morbidity and mortality, nutritional status, and LOS. Statistical analysis included descriptive statistics, univariate analysis, and multivariate analysis.
Results
A total of 186 patients were identified. Three patients had an LOS of more than 100 days and were omitted from the analysis. The median LOS was 8 days. Multivariate analysis showed only two variables: coronary artery disease (CAD) and postoperative complications were predictive of prolonged LOS. Chronic obstructive pulmonary disease (COPD) was the only preoperative morbidity predictive of complications.
Conclusions
The aim of this study was to identify factors that prolong LOS after colorectal surgery in a VA population. We found that CAD and postoperative complications were the only variables predictive of prolonged LOS after colorectal resection, and COPD was the only factor predictive of postoperative complications.
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References
Mongan JJ, Ferris TG, Lee TH (2008) Options for slowing the growth of health care costs. N Engl J Med 358:1509–1514
Nascimbeni R, Cadoni R, Di Fabio F et al (2005) Hospitalization after open colectomy: expectations and practice in general surgery. Surg Today 35:371–376
Schoetz DJ Jr, Bockler M, Rosenblatt MS et al (1997) “Ideal” length of stay after colectomy: whose ideal? Dis Colon Rectum 40:806–810
King PM, Blazeby JM, Ewings P et al (2006) The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis 8:506–513
Stephen AE, Berger DL (2003) Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection. Surgery 133:277–282
Deenadayalu VP, Rex DK (2007) Colorectal cancer screening: a guide to the guidelines. Rev Gastroenterol Disord 7:204–213
Franklin ME, Kazantsev GB, Abrego D et al (2000) Laparoscopic surgery for stage III colon cancer: long-term follow-up. Surg Endosc 14:612–616
Vargas HD, Ramirez RT, Hoffman GC et al (2000) Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 43:1726–1731
Faynsod M, Stamos MJ, Arnell T et al (2000) A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg 66:841–843
Bardram L, Funch-Jensen P, Jensen P et al (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345:763–764
Widmaier U, Karrer M, Schoenberg MH (2007) “Fast-track” and elective, laparoscopic colo-rectal surgery. Zentralbl Chir 132:342–348
Sailhamer EA, Sokal SM, Chang Y et al (2007) Environmental impact of accelerated clinical care in a high-volume center. Surgery 142:343–349
Schwenk W, Gunther N, Wendling P et al (2008) “Fast-track” rehabilitation for elective colonic surgery in Germany: prospective observational data from a multi-centre quality assurance programme. Int J Colorectal Dis 23:93–99
Raue W, Haase O, Junghans T et al (2004) ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 18:1463–1468
McNicol L, Story DA, Leslie K et al (2007) Postoperative complications and mortality in older patients having non-cardiac surgery at three Melbourne teaching hospitals. Med J Aust 186:447–452
Khuri SF, Henderson WG, DePalma RG et al (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341
Kiran RP, Delaney CP, Senagore AJ et al (2004) Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg 198:877–883
Tartter PI (1988) Determinants of postoperative stay in patients with colorectal cancer: implications for diagnostic-related groups. Dis Colon Rectum 31:694–698
Abbas S, Booth M (2003) Major abdominal surgery in octogenarians. N Z Med J 116:U402
Koperna T, Kisser M, Schulz F (1997) Emergency surgery for colon cancer in the aged. Arch Surg 132:1032–1037
Keller SM, Markovitz LJ, Wilder JR et al (1987) Emergency surgery in patients aged over 70 years. Mt Sinai J Med 54:25–28
Keller SM, Markovitz LJ, Wilde JR et al (1987) Emergency and elective surgery in patients over age 70. Am Surg 53:636–640
Tartter PI (1996) Postoperative stay associated with prognosis of patients with colorectal cancer. Ann Surg 223:351–356
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Leung, A.M., Gibbons, R.L. & Vu, H.N. Predictors of Length of Stay Following Colorectal Resection for Neoplasms in 183 Veterans Affairs Patients. World J Surg 33, 2183–2188 (2009). https://doi.org/10.1007/s00268-009-0148-6
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DOI: https://doi.org/10.1007/s00268-009-0148-6