Abstract
BackgroundLength 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.MethodsThis 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.ResultsPatients' 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.ConclusionsMalnutrition, 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.
Highlights
Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs
Using the Patient Generated Subjective Global Assessment (PG-SGA), we have observed high levels of nutritional deficiencies among patients with gynecological cancer, especially those diagnosed with ovarian cancer [17,18], but to date no study has assessed whether the scored PG-SGA can predict prolonged LOS among gynecological cancer patients
Data on patients' weight, body mass index, albumin and PG-SGA have been reported in previous publications [17,22]
Summary
Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Reducing length of hospital stay (LOS) has the potential to decrease health care cost, risk of infections and other hospital acquired diseases, and to improve patients' quality of life (QOL). Malnutrition has been found to be associated with increased risk of morbidity and mortality, complication rates such as wound infections, costs of hospitalisation, and decreased QOL in various cancer populations [2,4,6,7,8,9,10,11,12,13,14,15,16]. Using the PG-SGA, we have observed high levels of nutritional deficiencies among patients with gynecological cancer, especially those diagnosed with ovarian cancer [17,18], but to date no study has assessed whether the scored PG-SGA can predict prolonged LOS among gynecological cancer patients
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