The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients

Chiu, Herng‐Chia; Lin, Ying‐Chin; Hsieh, Hui‐Min; Chen, Hsin-Pao; Wang, Huili; Wang, Jaw‐Yuan

doi:10.1177/0300060516684087

Cited by 23 publications

(14 citation statements)

References 33 publications

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“…These results were consistent with previous studies regarding the immediate advantage of innovated surgical procedures [8–11, 13, 15]. The post-surgical length of hospital stay is a better indicator of CRC surgical outcomes [39]. Our study indicated that MLS patients stayed 2 days fewer after the surgery than conventional open surgery patients (10.63 vs. 13.01 days), possibly due to less pains or complications after surgery.…”

Section: Discussionsupporting

confidence: 92%

“…We measured clinical outcomes (e.g., blood transfusions, major and minor surgical complications rates, and length of hospital stay) and healthcare utilization during index hospitalization between MLS and conventional surgery patients. Types of complications were identified, including major surgical complications (e.g., anastomotic leakage, sepsis, abdominal abscess, respiration failure, pneumonia, bleeding, and other major complications) and minor surgical complications (e.g., urinary tract infection, intestinal obstruction, abdominal wound infection, gastrointestinal tract bleeding, and other minor complications) [39]. In addition, we calculated 1-year life-years (LYs) and quality-adjusted life-years (QALYs) as effectiveness measures given that innovative treatment may decrease risks of surgical complications or death and thus increase LYs.…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of mini-laparotomy in patients with colorectal cancers: A propensity scoring matching approach

et al. 2019

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ObjectiveSurgical technique process innovations are expected to generally incur no additional cost but gain better quality. Whether a mini-laparotomy surgery (MLS) in the treatment of colorectal cancer (CRC) is more cost effective than conventional open surgery had not been well examined. The objective of this study was to apply cost-effectiveness approaches to investigate the cost effectiveness of adopting MLS compared with open surgery 1 year following resection in CRC patients.Research designA prospective non-randomized cohort study designSettingAn academic medical centerParticipantsA total of 224 patients who received elective MLS and 339 who received conventional surgery; after propensity score matching, 212 pairs were included for analysis.InterventionNoneMain outcome measuresCost measures were hospital-index cost and outpatient and inpatient costs within 1 year after discharge. Effectiveness measures were life-years (LYs) gained and quality-adjusted life-year (QALYs) gained.Statistical methodsWe calculated incremental costs and effectiveness by differences in these values between MLS and conventional surgery using adjusted predicted estimates.ResultsMLS patients had lower rates of blood transfusions, less complication, and shorter post-surgical lengths of stay and more medical cost savings. One-year overall medical costs for MLS patients were TWD 748,269 (USD 24,942) per QALY gained, significant lower than for the comparison group (p-value = 0.045).ConclusionOur findings supported that the less invasive surgical process through MLS not only saved medical costs, but also increased QALYs for surgical treatment in CRC patients.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of mini-laparotomy in patients with colorectal cancers: A propensity scoring matching approach

et al. 2019

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“…Length of hospital stay (LOS) following surgical cancer care is an important measure of short-term quality of care. Prolonged LOS increases medical resource utilization, overall cost, readmissions, and short-term mortality [6,7]. Longer hospitalizations are also associated with iatrogenic and hospital-acquired sequelae that contribute to increased morbidity and mortality [8].…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

et al. 2019

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Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.

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“…[ 23 ] Prolonged PLOS was defined as a length of a post-operative inpatient stay longer than the median PLOS observed in the study. [ 24 ] Post-operative mortality was defined as deaths occurring during the same hospitalisation or within 30 days of the primary surgery. [ 8 ] Prospective data collection by the treating clinicians and dedicated data managers ensured the accuracy of the data.…”

Section: Methodsmentioning

confidence: 99%

Short- and long-term outcomes of laparoscopic-assisted surgery, mini-laparotomy and conventional laparotomy in patients with Stage I-III colorectal cancer

et al. 2018

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Background:Three operative techniques have been used for colorectal cancer (CRC) resection: Conventional laparotomy (CL) and the mini-invasive techniques (MITs)– laparoscopic-assisted surgery (LAS) and mini-laparotomy (ML). The aim of the study was to compare the short- and long-term outcomes of patients undergoing the three surgical approaches for Stage I–III CRC resection.Patients and Methods:This study enrolled 688 patients with Stage I–III CRC undergoing curative resection. The primary endpoints were perioperative quality and outcomes. The secondary endpoints were oncological outcomes including disease-free survival (DFS), overall survival (OS) and local recurrence (LR).Results:Patients undergoing LAS had significantly less blood loss (P < 0.001), earlier first flatus (P = 0.002) and earlier resumption of normal diet (P = 0.025). Although post-operative complication rates were remarkably higher in patients undergoing CL than in those undergoing MITs (P = 0.002), no difference was observed in the post-operative mortality rate (P = 0.099) or 60-day re-intervention rate (P = 0.062). The quality of operation as assessed by the number of lymph nodes harvested and rates of R0 resection did not differ among the groups (all P > 0.05). During a median follow-up of 5.42 years, no significant difference was observed among the treatment groups in the rates of 3-year late morbidity, 3-year LR, 5-year LR, 5-year OS or 5-year DFS (all P > 0.05).Conclusions:Patients undergoing CL had higher post-operative morbidities. Moreover, the study findings confirm the favourable short-term and comparable long-term outcomes of LAS and ML for curative CRC resection. Therefore, both MITs may be feasible and safe alternatives to CL for Stage I-III CRC resection.

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The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients

Cited by 23 publications

References 33 publications

Cost-effectiveness of mini-laparotomy in patients with colorectal cancers: A propensity scoring matching approach

Cost-effectiveness of mini-laparotomy in patients with colorectal cancers: A propensity scoring matching approach

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Short- and long-term outcomes of laparoscopic-assisted surgery, mini-laparotomy and conventional laparotomy in patients with Stage I-III colorectal cancer

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