Factors Affecting Length of Stay Following Colonic Resection

Abstract

In-hospital length of stay (LOS) has become a valuable measure of outcomes following any operation, which also directly impacts cost. The aim of this study was to identify the factors that affect LOS after colonic resection. A retrospective analysis was performed of adult patients who underwent colonic resection over an 8-y period at a tertiary institution. Data collected included demographics, American Society of Anesthesiologists (ASA) score, preoperative comorbidities and medications, operative management, postoperative morbidity and mortality, and LOS. Statistical analysis included descriptive statistics and multiple logistic regression to identify variables predictive of prolonged LOS. A total of 899 consecutive patients were identified. One hundred eighty-seven resections were performed urgently, and 712 were elective. Two-hundred forty-five cases were performed laparoscopically. Complications occurred in 205 cases (23%), and there were 32 deaths (4%). The median LOS was 7 d. Logistic analysis showed 15 variables to be predictive of prolonged LOS. These included advanced age, warfarin sodium use, ASA score >or=3, alcoholism, chronic obstructive pulmonary disease, end-stage renal disease, illicit drug use, total colectomy (versus segmental), open resections (versus laparoscopic), and postoperative complications. In addition, the presence of at least one postoperative complication was predictive of prolonged LOS (P = 0.0002, OR 2.4 95% CI 1.5-3.8). ASA score and the incidence of postoperative complications are the only significant categories of variables that predict prolonged LOS after colectomy. Laparoscopic approach and the extent of the resection are predictive as well.