PROLONGED POSTOPERATIVE STAY AFTER ELECTIVE COLORECTAL SURGERY IS ASSOCIATED WITH IV FLUID VOLUME, OLDER PATIENT, AND PROLONGED OPEN OPERATION
Kelsey Koch*1, Alexander Hart2, Amanda Kahl2, Mary Charlton2, Muneera Kapadia1, Jennifer Hrabe1, Imran Hassan1, John Cromwell1, Irena Gribovskaja-Rupp1
1Surgery, University of Iowa, Iowa City, IA; 2College of Public Health, University of Iowa, Iowa City, IA
Introduction:
Prolonged length of stay (LOS) (>5 days) after elective colorectal surgery is associated with increased morbidity and greater socioeconomic burden. Elective surgery allows for preoperative patient optimization and discharge planning, yet a significant number of patients still stay longer than 5 days. The purpose of this study is to investigate risk factors associated with prolonged LOS in elective colorectal surgery under an aggressive ERAS protocol.
Methods:
All elective colorectal cases performed at University of Iowa between 1/2015 and 3/2018 were analyzed retrospectively in NSQIP format with additional variables. All cases were performed at a tertiary care academic center by colorectal surgeons using a standardized ERAS protocol. Sociodemographics, indication, approach, enteric outlet, co-morbidities, complications, LOS, preoperative benzodiazepine/opioid use, IV lidocaine use, and amount of IV fluids received were recorded. Prolonged stay was defined as LOS >5 days. Multivariate logistic regression analysis was performed to determine association with LOS>5 days with the data points studied. This study was approved by the Institutional Review Board at University of Iowa Hospitals and Clinics.
Results:
A total of 464 cases were analyzed; 222 (48%) were male and average age was 58 (±15.3). 263 (47%) patients had LOS ≥5 days. Patients aged 70 or older had greater odds of LOS ≥5 days when compared to patients under the age of 50 (OR 2.45, 95%CI 1.286-4.678). Open operative approach had greater risk of LOS ≥5 days when compared to minimally invasive surgeries (OR 3.66, 95%CI 2.278-5.887). Operative time progressively increased the risk of LOS ≥5 days (240-359 min: OR 3.39, 95%CI 1.645-7.001, >360 min: OR 4.63, 95%CI 2.012-10.653, all compared to <120 min). IV fluid administration was a strong progressive indicator of LOS ≥5 days: ≥3000 mL over first 72 hours increased risk of prolonged stay compared to <2000 mL (including intraoperative) (OR 8.27, 95% CI 4.112-16.644); higher amounts of IVF had a stronger association. There was no significant difference in LOS in patients that received IV lidocaine intraoperatively or who were taking preoperative benzodiazepines or narcotics.
Discussion:
Prolonged hospital stay is associated with older age, increased volume of perioperative IV fluids (over 2000 mL), and long open operations. This work refines our understanding of modifiable factors that will impact LOS in colorectal patients and can be used in existing ERAS programs to enhance patient outcomes.
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