Perioperative factors predicting delayed enteral resumption and hospital length of stay in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Retrospective cohort analysis from a single centre in India

Abstract

Background and Aims: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an extensive procedure associated with significant morbidity, delay in return of gastrointestinal function and discharge from hospital. Our aim was to assess perioperative factors influencing enteral resumption (ER) and length of stay in the hospital (LOS) in CRS-HIPEC. Methods: A retrospective analysis was conducted in a major tertiary cancer centre. Sixty-five patients who underwent CRS-HIPEC between July 2014 and March 2019 were included in the study. The perioperative data were collected from patient records. The primary outcome measure was day of oral resumption of 500 ml of clear fluids and secondary outcome was the LOS. Univariate and multivariate logistic regression analysis was done for the various continuous and categorical perioperative variables for both ER and LOS to elicit the magnitude of risk for both outcomes. Results: Univariate logistic regression revealed that peritoneal carcinomatosis index score (PCI), duration of surgery, blood loss and postoperative ventilation influenced both ER and LOS. Serum albumin, plasma usage and total peritonectomy affected only the LOS but not ER. Multivariate analysis showed that duration of surgery ( P = 0.006) and quantum of intravenous fluid infused ( P = 0.043) were statistically associated with ER, while serum albumin level ( P = 0.025) and postoperative ventilation ( P = 0.045) were independently predictive of LOS. Conclusion: CRS-HIPEC is an extensive surgery and multiple factors are associated with ER; of these, duration of surgery and intraoperative fluid therapy are significant factors. Low serum albumin and prolonged postoperative ventilation are associated with increased LOS.

Early Postoperative Extubation is Associated with Shorter Hospitalization and Improved Short-Term Survival in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

“…Our findings of shortened hospital LOS with early postoperative extubation are similar to those demonstrated by Balakrishnan et al, who recently reported improved LOS in patients with early postoperative extubation after undergoing CRS/HIPEC. 17 In that study of 65 patients with mixed pathology, by multivariate analysis, the absence of any need for postoperative ventilation (OR 6.32, P = .045) as well as improved preoperative nutritional status as demonstrated by preoperative albumin level (OR .208, P = .025) were associated with improved hospital LOS.…”

Minimising statistical errors in the research domain: Time to work harder and dig deeper!

“…The utilisation of univariate analysis and multiple regression by a few authors, however, is noteworthy. [ 23 24 25 ] What constitutes additional or advanced statistics is a matter of subjective opinion. Multiple regression with at least three predictors, factor analysis, and cluster analysis (cluster observations or k-means clustering), discriminant analysis and a time-series analysis do constitute additional tests.…”

A tripartite challenge of orphaned manuscripts, heedless writing and reluctant reviewing...... revamping the editing process!

“…Systematic reviews, meta-analysis and randomised controlled trials occupy the highest position in evidence-based medicine, but in spite of this academic awareness, authors are nowadays resorting to quick research recipes like retrospective studies and online surveys. [ 3 ] The small number of meta-analyses[ 4 5 6 ] and large number of surveys[ 7 8 9 10 11 ] and retrospective studies[ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] published in the IJA in the last few years are an evidence to this. The commonly known inverse ratio of quantity to quality has also been equally observed at IJA with this enhanced submission process.…”