Impact of Post-Operative Ileus (POI) on Hospital Length of Stay in Colectomy Surgery Patients

Abstract

Purpose: To study the impact of postoperative ileus (POI) on hospital length of stay in colectomy patients. Methods: A retrospective cohort study design was used. Adult patients with a principal procedure code for partial excision of large intestine (ICD-9 code: 45.71–45.79), discharged between Jan 2004–Dec 2004 were identified from Premier's Perspective Comparative Database, an inpatient records database from over 500 hospitals in the United States. The colectomy patients were further classified for the presence of POI, by the presence of paralytic ileus (ICD-9 code 560.1) and/or digestive system complications (ICD-9 code 994.1) during the study period. Multivariate hierarchical regression analysis was performed with log-transformed length of stay as the dependent variable. Patient demographics, mortality risk, disease severity, admission source, payment type, and hospital characteristics were used as covariates. Results: A total of 17,896 patients with a primary procedure code for colectomy were identified, of which 3,115 (17.4%) patients had a secondary diagnosis of POI, including paralytic ileus (N = 2,732; 15.3%) and digestive system complications (N = 1,899, 10.6%), with significant overlap between the two (N = 1516, 8.5%). The majority of colectomy patients with POI were male (54.9%), Caucasian (70.9%) and in the 51–64 year age group (51%). The crude average hospital length of stay was significantly higher (P < 0.001) in colectomy patients with POI (13.75 ± 13.33 days) compared with patients without POI (8.85 ± 9.49 days). Presence of POI was found to significantly increase hospital length of stay (antilog b = 1.29, P < 0.001) in the regression model. Gender (P < 0.01), severity level (P < 0.001), admission source (P < 0.05) and hospital size (P < 0.05) were other significant predictors of hospital length of stay. Conclusion: Postoperative Ileus (POI) is associated with a significant increase in the hospital length of stay in colectomy patients. Prevention of POI in colectomy patients could potentially decrease hospital length of stay and reduce costs.