Determinants of Hospital Stay Duration Post-Colorectal Surgery

Abstract

Introduction: Hospital length of stay (LOS) remains a vital metric for assessing patient outcomes and healthcare resource utilization. Given the substantial financial impact of diagnosing and treating colorectal anomalies, coupled with an increased susceptibility to postoperative complications, it is crucial to understand the factors affecting LOS following colorectal surgery. Our primary objective was to investigate the preoperative, intraoperative, and postoperative risk factors that have substantial influence over LOS following a colorectal procedure. Methods: This study analyzed data from a retrospective study of adults who underwent various colorectal surgeries (colostomy, ileostomy, small bowel resection, etc.) at Cleveland Clinic Foundation (January 2005- December 2014). Predictor variables were categorized into preoperative (patient demographics, medical history, comorbidities, lifestyle factors), intraoperative, and postoperative factors. LOS was grouped into short-term (SLOS) (≤ 7 days), medium-term (MLOS) (8-30 days), and long-term (LLOS) (> 30 days) stays. Multinomial logistic regression models assessed predictor effects on LOS. Results: Among the 7874 patients, 50.7% were females, with a minimum age of 20 years. SLOS were observed in 61.1%, MLOS in 37.6%, and LLOS in 1.3% of patients. Advanced age correlated with prolonged LOS, possibly due to age-related health challenges like weak immune systems. Coagulopathy, and fluid and electrolyte disorders raised MLOS and LLOS risk, likely due to complications like significant bleeding and electrolyte imbalances. Surgery duration predicted longer LOS, elevating LLOS and MLOS by 52% and 42%. Postoperative infections were associated to extended stays, possibly due to subsequent interventions, monitoring and recovery delays. Conclusion: Our study revealed that key preoperative predictors of LOS included Age, coagulopathy, fluid and electrolyte disorders, severe weight loss, and drug abuse. Notably, intraoperative factors such as surgical approach (open vs laparoscopic) and surgery duration, alongside postoperative complications including superficial and serious infections, significantly influenced LOS. By incorporating these insights into the preoperative planning, clinicians could potentially develop tailored interventions to mitigate risk factors and enhance postoperative recovery, thus potentially reducing LOS and improving patient outcomes.

Keywords

• Colorectal surgery; Hospital length of stay; Preoperative factors; Intraoperative factors; Postoperative complications; Risk factors