Timing of complications and length of stay after rectal cancer surgery.

Details

Serval ID
serval:BIB_9F2ACA4E1533
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Timing of complications and length of stay after rectal cancer surgery.
Journal
Journal of the American College of Surgeons
Author(s)
Huebner M., Hübner M., Cima R.R., Larson D.W.
ISSN
1879-1190 (Electronic)
ISSN-L
1072-7515
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
218
Number
5
Pages
914-919
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
BACKGROUND: Enhanced recovery pathways have been shown to improve short-term outcomes after colorectal surgery. Occurrence of complications can lead to prolonged length of stay (LOS). The goal of this study was to examine whether shorter time to occurrence of complications was associated with a shorter hospital LOS in rectal cancer patients undergoing minimally invasive surgery, taking into account the perioperative pathway.
STUDY DESIGN: This retrospective study included consecutive patients undergoing rectal cancer resection from 2005 to 2011 at a single institution. Enhanced recovery pathway was introduced in 2009. Complications and date of occurrence were reviewed. The impact of perioperative care modalities and comorbidities was evaluated using competing risk models with occurrence of complications and LOS as time-dependent outcomes measured as time from surgery.
RESULTS: A total of 346 patients were included in the analysis with 78 patients treated with enhanced recovery pathway, and 268 with established care. The overall complication rate was 22.3% (77 patients with ileus, wound infection, leak, abscess, small bowel obstruction, reoperation for bleeding, and renal failure). Median time to occurrence of a complication was 3 days post operation. The time to complication diagnosis was associated with shorter time to discharge after the advent of the complication (hazard ratio = 0.84; 95% CI, 0.73-0.96; p = 0.01). Enhanced recovery pathway was associated with a shorter LOS for patients without complications compared with the established pathway (hazard ratio = 2.81; 95% CI, 2.09-3.78; p < 0.001) after adjusting for comorbidities in a competing risk model.
CONCLUSIONS: Early diagnosis of postoperative complications is associated with a shorter LOS after rectal cancer surgery. Enhanced recovery pathway can facilitate a faster recovery in the presence of comorbidities.
Keywords
Colectomy/adverse effects, Colectomy/methods, Female, Follow-Up Studies, Humans, Incidence, Length of Stay/trends, Male, Middle Aged, Minimally Invasive Surgical Procedures/adverse effects, Odds Ratio, Postoperative Complications/epidemiology, Prognosis, Rectal Neoplasms/surgery, Retrospective Studies, Risk Assessment/methods, Survival Rate/trends, Time Factors, hic" UI="D014481">United States/epidemiology
Pubmed
Web of science
Create date
20/01/2015 14:48
Last modification date
20/08/2019 16:05
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