A retrospective observational study of length of stay in hospital after colorectal cancer surgery in England (1998–2010)

Abstract

The National Health Service (NHS) is facing financial constraints and thus there is considerable interest in ensuring the shortest but optimal hospital stays possible. The aim of this study was to investigate patterns of postoperative length of stay (LOS) stay across the English NHS and to identify factors that significantly influence both optimal and prolonged LOS.Data were obtained from the National Cancer Data Repository (NCDR). National patterns of LOS were examined and multilevel mixed effects logistic regression was used to study factors associated with an “ideal” (≤5 days) or a prolonged (≥21 days) LOS in hospital after major resection. Funnel plots were used to examine variation across hospitals in both risk-adjusted and unadjusted LOS.All 240,873 individuals who underwent major resection for colorectal cancer were diagnosed between 1998 and 2010 in the English NHS. The overall median LOS was 10 (interquartile range [IQR] 7–14 days) days, but it fell over time from 11 (IQR 9–15) days in 1998 to 7 (IQR 5–12) days in 2010. The proportion of people experiencing “ideal” LOS increased dramatically from 4.9% in 1998 to 34.2% in 2010, but the decrease in the proportion of patients who experienced a prolonged LOS was less marked falling from 11.2% to 8.4%, respectively. Control charts showed that there was significant variation in short and prolonged LOS across NHS trusts even after adjustment for case-mix.Significant variation in LOS existed between NHS hospitals in England throughout period 1998 to 2010. Understanding the underlying causes of this variation between surgical providers will make it possible to identify and spread best practice, improve services, and ultimately reduce LOS following colorectal cancer surgery.

Intrinsic predictors of prolonged length of stay in a colorectal enhanced recovery pathway: a prospective cohort study and multivariate analysis

“…Our median LOS is longer than that reported in ERP research cohorts [6,8,12,56]; it is comparable to UK ERP data, which include the National Bowel Cancer Audit Programme [26,27,57,58]. We think this justifies our use of the median LOS as the cut-off in defining pLOS.…”

Operative morbidity and mortality for colorectal cancer: 10-years’ experience

“…Some studies have reported a shorter post-operative hospital stay for females. 19 OMR in the present study was more for anterior resection than for abdominal perineal resection (APR) and more for left hemicolectomy than for right hemicolectomy. Whittaker and Goligher has reported higher mortality with APR than with anterior resection.…”

“…left hemicolectomy patients had a longer postoperative stay than that of right hemicolectomy patients. 19 Emergency operations associated with higher mortality and morbidity as these patients were taken up for surgery when are severely and acutely ill. The higher morbidity in these patients could be attributed to high incidence of sepsis due to lack of bowel preparation and antibiotic cover, intraperitoneal fecal contamination.…”

Hospital characteristics, rather than surgical volume, predict length of stay following colorectal cancer surgery

“…In 2016, the Victorian Auditor General identified $125 million per year in potential statewide savings from efficient LOS performance 2 . LOS is an important component in the delivery of efficient, high‐quality patient care 8 …”

“…Since Adams et al 9 in 1973 and Lufte et al 10 in 1979 reported a link between provider volume and successful surgical outcomes, provider volume has been used as a surrogate measure of hospital quality. Evidence of an association between hospital or surgeon cancer surgery volume and better patient outcomes has been mixed; 3,7,8,11–31 however, previous analyses have had important limitations. A 2002 review that examined seven statistical modelling techniques used to assess association between patient factors and LOS in a cardiovascular setting found that choice of model influenced the conclusion of the analyses.…”