title: Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study.
abstract: BACKGROUND
  Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS.
  
  
  METHODS
  This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS.
  
  
  RESULTS
  Patients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease/pelvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS.
  
  
  CONCLUSIONS
  Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.
authors.affiliation: Queensland Centre for Gynaecological Cancer, Level 6 Ned Hanlon Building, The Royal Brisbane and Women's Hospital, Herston Queensland 4029, Australia.
authors.forename: Brenda
authors.initials: B
authors.lastname: Laky
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cleghorn
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D044342:Malnutrition / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D011793:Queensland; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome