title: Actual versus estimated length of stay after colorectal surgery: which factors influence a deviation?
abstract: BACKGROUND
  The aim of this study was to determine factors associated with deviation in length of hospital stay (LOS) from that determined by diagnosis-related groups.
  
  
  METHODS
  A cohort study from a prospectively collected database was conducted, including consecutive patients undergoing surgery in a high-volume colorectal surgery department in 2009.
  
  
  RESULTS
  For 1,461 included patients, average expected and actual LOS were 8.17 days (interquartile range, 4.7 to 11.9 days) and 8.31 days (interquartile range, 4 to 10 days), respectively. The most prominent factors associated with an increase of LOS from expected were parenteral nutrition (5.11 days), emergency room admittance (3.67 days), and ileus (3.45 days) (P ≤ .001 for all). Other independently associated factors included blood transfusion, anastomotic leak, sepsis, pulmonary embolism, and surgeon. Patients with higher severity illness indexes and longer postoperative intensive care stay had lower than expected LOS.
  
  
  CONCLUSIONS
  After colorectal surgery, several modifiable factors are associated with deviation of LOS from expected. An opportunity hence exists to reduce both LOS and financial burden for hospitals in an era of pay for performance.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Usama
authors.initials: U
authors.lastname: Ahmed Ali
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Dunne
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Gurland
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Vogel
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: kiranp@ccf.org.
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D003108:Colonic Diseases / Q000601:surgery; D003107:Colorectal Surgery / Q000191:economics / Q000592:standards*; D003953:Diagnosis-Related Groups / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D011446:Prospective Studies; D012052:Reimbursement, Incentive; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Colorectal surgery; Diagnosis-related group; Length of hospital stay