"Ideal" length of stay after colectomy: whose ideal?
OBJECTIVE
In response to external pressure to achieve an idealized length of stay after colon resection, a study was designed to define perioperative factors that significantly impact average length of stay (ALOS).


METHODS
We retrospectively reviewed the records of 226 patients undergoing open colon resection from 1988 to 1995 to determine the effects of age, type of procedure, nature of the procedure (elective vs. emergency), and postoperative course on ALOS. Statistics were calculated by Student's t-test, chi-squared analysis, and analysis of variance.


RESULTS
Average length of stay was 10 (range, 4-34) days, with a significant trend toward lower ALOS in recent years; ALOS in 1988 averaged 11 days, whereas in 1994, ALOS averaged 9 days (r2 = 0.118; P < 0.001). Patients younger than 65 years of age had an ALOS of 9 days vs. 11 days in patients older than 65 years (P = 0.0024). Patients with anastomoses on the right and left side had similar ALOS (8.5 vs. 9.1 days), whereas creation of a stoma was associated with a significantly higher ALOS (12.1 days; P < 0.00001). The need for postoperative nasogastric intubation (14.9 vs. 9.3 days) and the performance of emergency operations (12.2 vs. 6.5 days) were also associated with a significantly higher ALOS (P < 0.00001).


CONCLUSIONS
Caution must be exercised in accepting rigid criteria for length of stay for patients undergoing colorectal resections, as uncontrollable clinical variables are involved in defining the "ideal" patient.
Schoetz
D J
DJ
Department of Colon and Rectal Surgery, Lahey Hitchcock Medical Center, Burlington, Massachusetts 01805, USA.
Bockler
M
M
Rosenblatt
M S
MS
Malhotra
S
S
Roberts
P L
PL
Murray
J J
JJ
Coller
J A
JA
Rusin
L C
LC
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D003125:Colostomy / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000601:surgery; D017558:Elective Surgical Procedures; D004630:Emergencies; D006760:Hospitalization; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008404:Massachusetts / Q000453:epidemiology; D015999:Multivariate Analysis; D011182:Postoperative Care; D012044:Regression Analysis; D012189:Retrospective Studies