M. M. Mrdutt2, C. Shaver2, C. Isbell2, R. Essani2, R. Warrier2, J. S. Thomas2, H. T. Papaconstantinou2 2Scott & White Healthcare,Temple, Texas, USA
Introduction:
Colorectal surgery carries inherent risks and complications. In contemporary healthcare, quality and cost drive value. Length of hospital stay (LOS) is an indirect measure of quality and cost as LOS is influenced by post-operative complications and the average hospital cost is >$1600/day. However, the impact of specific complications on LOS is not well defined. The purpose of this study is to determine the contribution of specific complications to the LOS in elective laparoscopic colectomy patients with malignancy.
Methods:
ACS NSQIP database (2011-2014) was queried for patients undergoing elective laparoscopic partial colectomy due to malignancy. Demographics, 30-day post-operative complications (superficial surgical site infections (superficial SSIs), wound occurrences, return to OR, transfusion requirement, sepsis, pulmonary outcomes, DVT/PE, acute renal failure, urinary tract infection (UTI) and cardiac outcomes) and length of stay were evaluated. Wound occurrences include deep and organ space SSIs as well as wound disruption or dehiscence. A logistic regression model based on LOS and demographic variables for each individual complication was performed to determine LOS impact. Significance set at p<0.05.
Results:
59,118 patients were evaluated. Over 70% were age 50-79, 34.6% obese (BMI ±30), mean BMI 28.6, 47.5% male and 5.3% with current immunosuppression. Overall mean LOS was 5.4 days. Observed rate of complications and associated average expected LOS are listed for infectious complications (Table 1). Complications including return to OR, transfusion requirements, failure to wean from ventilator, reintubation, deep vein thrombosis, pulmonary embolism, cardiac complications (MI or cardiac arrest) and acute renal failure also all increased expected LOS by at least two additional days (p<0.0001). Right parital colectomy (23%) versus left/sigmoidectomy (77%) was not statistically significant in the multi-variant analysis for LOS (p = 0.095).
Conclusion:
Post-operative complications increase LOS in laparoscopic colectomy patients undergoing elective resection of malignancy, with superficial SSIs increasing predicted LOS by 2 days, wound occurrences by 6 days and pneumonia by roughly a week in addition to average baseline LOS of 5.4 days. By identifying the financial impact of complications, with LOS as a surrogate for cost, future QI efforts can target high yield post-operative complications to improve care and minimize health care cost.
