Determinants of postoperative stay in patients with colorectal cancer. Implications for diagnostic-related groups.
The easiest way to reduce the cost of hospital care for patients is to reduce the length of hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative length of stay for 320 consecutive colorectal cancer patients undergoing elective surgery during a three-year period. Prolonged postoperative stays were noted for patients over age 69. Significantly longer stays were seen for men than for women (13.9 vs. 11.9 days, P = .012). Operative procedure significantly influenced postoperative stay: left hemicolectomies, anterior resections with colostomy, abdominoperineal resections, and subtotal colectomies were associated with significantly longer stays than right, transverse, sigmoid, and anterior resections without colostomy (P less than .001). Complications increased the mean postoperative stay from 11.4 to 19.7 days (P less than .001) and stay increased progressively with the number of blood transfusions received from 11.1 days for no blood to 21.6 days for more than four units (P less than .001). Severity of disease, as reflected by Dukes' stage, tumor differentiation, and tumor size, was not related to postoperative stay. In the latter half of the study, postoperative stay declined, accompanied by a decline in the use of blood and a shift in the procedures performed for rectal carcinoma away from abdominoperineal resection toward anterior resection without colostomy. Diagnosis-related group (DRG) relative weights for procedure, age, and complications are at variance with these findings.
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D003363:Cost Control; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009519:New York City; D011183:Postoperative Complications / Q000191:economics; D012307:Risk Factors; D012737:Sex Factors; D013223:Statistics as Topic; D013997:Time Factors