Skip to main content
Erschienen in: World Journal of Surgery 10/2009

01.10.2009

Predictors of Length of Stay Following Colorectal Resection for Neoplasms in 183 Veterans Affairs Patients

verfasst von: Anna M. Leung, R. L. Gibbons, Huan N. Vu

Erschienen in: World Journal of Surgery | Ausgabe 10/2009

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Mongan JJ, Ferris TG, Lee TH (2008) Options for slowing the growth of health care costs. N Engl J Med 358:1509–1514PubMedCrossRef Mongan JJ, Ferris TG, Lee TH (2008) Options for slowing the growth of health care costs. N Engl J Med 358:1509–1514PubMedCrossRef
2.
Zurück zum Zitat Nascimbeni R, Cadoni R, Di Fabio F et al (2005) Hospitalization after open colectomy: expectations and practice in general surgery. Surg Today 35:371–376PubMedCrossRef Nascimbeni R, Cadoni R, Di Fabio F et al (2005) Hospitalization after open colectomy: expectations and practice in general surgery. Surg Today 35:371–376PubMedCrossRef
3.
Zurück zum Zitat Schoetz DJ Jr, Bockler M, Rosenblatt MS et al (1997) “Ideal” length of stay after colectomy: whose ideal? Dis Colon Rectum 40:806–810PubMedCrossRef Schoetz DJ Jr, Bockler M, Rosenblatt MS et al (1997) “Ideal” length of stay after colectomy: whose ideal? Dis Colon Rectum 40:806–810PubMedCrossRef
4.
Zurück zum Zitat 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 8:506–513PubMedCrossRef 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 8:506–513PubMedCrossRef
5.
Zurück zum Zitat 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 133:277–282PubMedCrossRef 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 133:277–282PubMedCrossRef
6.
Zurück zum Zitat Deenadayalu VP, Rex DK (2007) Colorectal cancer screening: a guide to the guidelines. Rev Gastroenterol Disord 7:204–213PubMed Deenadayalu VP, Rex DK (2007) Colorectal cancer screening: a guide to the guidelines. Rev Gastroenterol Disord 7:204–213PubMed
7.
Zurück zum Zitat Franklin ME, Kazantsev GB, Abrego D et al (2000) Laparoscopic surgery for stage III colon cancer: long-term follow-up. Surg Endosc 14:612–616PubMedCrossRef Franklin ME, Kazantsev GB, Abrego D et al (2000) Laparoscopic surgery for stage III colon cancer: long-term follow-up. Surg Endosc 14:612–616PubMedCrossRef
8.
Zurück zum Zitat Vargas HD, Ramirez RT, Hoffman GC et al (2000) Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 43:1726–1731PubMedCrossRef Vargas HD, Ramirez RT, Hoffman GC et al (2000) Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 43:1726–1731PubMedCrossRef
9.
Zurück zum Zitat Faynsod M, Stamos MJ, Arnell T et al (2000) A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg 66:841–843PubMed Faynsod M, Stamos MJ, Arnell T et al (2000) A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg 66:841–843PubMed
10.
Zurück zum Zitat 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 345:763–764PubMedCrossRef 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 345:763–764PubMedCrossRef
11.
Zurück zum Zitat Widmaier U, Karrer M, Schoenberg MH (2007) “Fast-track” and elective, laparoscopic colo-rectal surgery. Zentralbl Chir 132:342–348PubMedCrossRef Widmaier U, Karrer M, Schoenberg MH (2007) “Fast-track” and elective, laparoscopic colo-rectal surgery. Zentralbl Chir 132:342–348PubMedCrossRef
12.
Zurück zum Zitat Sailhamer EA, Sokal SM, Chang Y et al (2007) Environmental impact of accelerated clinical care in a high-volume center. Surgery 142:343–349PubMedCrossRef Sailhamer EA, Sokal SM, Chang Y et al (2007) Environmental impact of accelerated clinical care in a high-volume center. Surgery 142:343–349PubMedCrossRef
13.
Zurück zum Zitat 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 23:93–99PubMedCrossRef 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 23:93–99PubMedCrossRef
14.
Zurück zum Zitat 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 18:1463–1468PubMedCrossRef 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 18:1463–1468PubMedCrossRef
15.
Zurück zum Zitat 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 186:447–452PubMed 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 186:447–452PubMed
16.
Zurück zum Zitat 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 242:326–341PubMed 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 242:326–341PubMed
17.
Zurück zum Zitat Kiran RP, Delaney CP, Senagore AJ et al (2004) Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg 198:877–883PubMedCrossRef Kiran RP, Delaney CP, Senagore AJ et al (2004) Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg 198:877–883PubMedCrossRef
18.
Zurück zum Zitat Tartter PI (1988) Determinants of postoperative stay in patients with colorectal cancer: implications for diagnostic-related groups. Dis Colon Rectum 31:694–698PubMedCrossRef Tartter PI (1988) Determinants of postoperative stay in patients with colorectal cancer: implications for diagnostic-related groups. Dis Colon Rectum 31:694–698PubMedCrossRef
19.
Zurück zum Zitat Abbas S, Booth M (2003) Major abdominal surgery in octogenarians. N Z Med J 116:U402PubMed Abbas S, Booth M (2003) Major abdominal surgery in octogenarians. N Z Med J 116:U402PubMed
20.
Zurück zum Zitat Koperna T, Kisser M, Schulz F (1997) Emergency surgery for colon cancer in the aged. Arch Surg 132:1032–1037PubMed Koperna T, Kisser M, Schulz F (1997) Emergency surgery for colon cancer in the aged. Arch Surg 132:1032–1037PubMed
21.
Zurück zum Zitat Keller SM, Markovitz LJ, Wilder JR et al (1987) Emergency surgery in patients aged over 70 years. Mt Sinai J Med 54:25–28PubMed Keller SM, Markovitz LJ, Wilder JR et al (1987) Emergency surgery in patients aged over 70 years. Mt Sinai J Med 54:25–28PubMed
22.
Zurück zum Zitat Keller SM, Markovitz LJ, Wilde JR et al (1987) Emergency and elective surgery in patients over age 70. Am Surg 53:636–640PubMed Keller SM, Markovitz LJ, Wilde JR et al (1987) Emergency and elective surgery in patients over age 70. Am Surg 53:636–640PubMed
23.
Zurück zum Zitat Tartter PI (1996) Postoperative stay associated with prognosis of patients with colorectal cancer. Ann Surg 223:351–356PubMedCrossRef Tartter PI (1996) Postoperative stay associated with prognosis of patients with colorectal cancer. Ann Surg 223:351–356PubMedCrossRef
Metadaten
Titel
Predictors of Length of Stay Following Colorectal Resection for Neoplasms in 183 Veterans Affairs Patients
verfasst von
Anna M. Leung
R. L. Gibbons
Huan N. Vu
Publikationsdatum
01.10.2009
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 10/2009
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0148-6

Weitere Artikel der Ausgabe 10/2009

World Journal of Surgery 10/2009 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.