title: Prediction of hospital stay after total gastrectomy.
abstract: The following factors were tested in the Cox proportional hazards model to determine their relationship to postoperative hospital stay in 174 patients who underwent total gastrectomy: age, sex, tumour stage, tumour free resection margins, anastomotic leakage, size of the EEA-stapler, preoperative hospital stay, location of the anastomosis and additional resection. Only anastomotic leakage and age independently affected postoperative hospital stay. Leakage, confirmed radiologically, developed in 20 patients (11.5%) of whom four died postoperatively. Another six patients who did not develop leakage also died, giving a postoperative mortality of 5.7%. The median age of the patients was 68 years (range 30-87), and the median postoperative hospital stay was 15 days (range 3-192). The operations were performed by 30 different surgeons of whom four performed more than ten, 9 performed 4-10 and 17 performed 1-3 total gastrectomies. There was a significant difference in postoperative mortality- and anastomotic leakage-rate between the surgeons who operated more than ten and less than four (p = 0.0122, p = 0.0453). However, when comparing the surgeons who operate more than 10 and 4-10 there was no difference in mortality or anastomotic leakage (p = 0.3493, p = 0.8867). When comparing the surgeons who operated on 4-10 with less than 4 there was no difference in postoperative mortality, but the anastomotic leakage rate was of borderline significance (p = 0.3916, p = 0.0582). Between the surgeons with the greatest experience there were significant differences as to leakage rate (p = 0.0003), time of operation (p < 0.001) but not in the number of thoracoabdominal incisions (p = 0.4939) or postoperative mortality (p = 0.8394). This study has shown conclusively that anastomotic leakage is the most important factor for prediction of postoperative hospital stay after total gastrectomy.
authors.affiliation: Department of Surgery, Lund University, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Zilling
authors.forename: P
authors.initials: P
authors.lastname: Olséen
authors.forename: B S
authors.initials: BS
authors.lastname: Walther
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis