Factors influencing super-long hospital stays in patients undergoing radical gastrectomy in the age of enhanced recovery after surgery.
10.3760/cma.j.cn441530-20220414-00149
- Author:
Y LIU
1
;
Z D CHEN
1
;
J X CUI
1
;
H CUI
2
;
W Q LIANG
2
;
K C ZHANG
2
;
Y H GAO
2
;
L CHEN
1
;
H Q XI
1
Author Information
1. Division of Abdominal Trauma Surgery, Senior Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
2. Division of Gastric Surgery, Senior Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Case-Control Studies;
Retrospective Studies;
Length of Stay;
Stomach Neoplasms/pathology*;
Enhanced Recovery After Surgery;
Gastrectomy/adverse effects*;
Postoperative Complications/etiology*
- From:
Chinese Journal of Gastrointestinal Surgery
2022;25(12):1104-1109
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To obtain experience and generate suggestions for reducing average hospital stays, optimizing perioperative management of patients with gastric cancer and improving utilization of medical resources by analyzing the factors influencing super-long hospital stays in patients undergoing radical gastrectomy in the age of enhanced recovery after surgery (ERAS). Methods: This was a case-control study. Inclusion criteria: (1) pathologically diagnosed gastric adenocarcinoma; (2) radical surgery for gastric cancer; and (3) complete clinicopathologic data. Exclusion criteria: (1) history of upper abdominal surgery; (2) presence of distant metastasis of gastric cancer or other ongoing neoplastic diseases; (3) concurrent chemoradiotherapy; and (4) preoperative gastric cancer-related complications such as obstruction or perforation. The study cohort comprised 285 eligible patients with hospital stays of ≥30 days (super-long hospital stay group). Using propensity score matching in a 1:1 ratio, age, sex, medical insurance, pTNM stage, and extent of surgical resection as matching factors, 285 patients with hospital stays of < 30 days during the same period were selected as the control group (non-long hospital stay group). The primary endpoint was relationship between pre-, intra-, and post-operative characteristics and super-long hospital stays. Clavien-Dindo grade was used to classify complications. Results: Univariate analysis showed that number of comorbidities, number of preoperative consultations, preoperative consultation, inter-departmental transference, operation time, open surgery, blood loss, intensive care unit time, presence of surgical or non-surgical complications, Clavien-Dindo grade of postoperative complications, and reoperation were associated with super-long hospital stays (all P<0.05). Inter-departmental transference (OR=4.876, 95% CI: 1.500-16.731, P<0.001), preoperative consultation time ≥ 3 d (OR=1.758, 95%CI: 1.036-2.733, P=0.034), postoperative surgery-related complications (OR = 6.618, 95%CI: 2.141-20.459, P=0.01), and higher grade of complications (Clavien-Dindo Grade I: OR = 7.176, 95%CI: 1.785-28.884, P<0.001; Clavien-Dindo Grade II: OR = 18.984, 95%CI: 6.286-57.312, P<0.001; Clavien-Dindo Grade III-IV: OR=7.546, 95%CI:1.495-37.952, P=0.014) were independent risk factors for super-long hospital stays. Conclusion: Optimizing preoperative management, enhancing perioperative management, and surgical quality control can reduce the risk of prolonging average hospital stay.
