Benchmarking of aggregated length of stay after open and laparoscopic surgery for cancers of the digestive system

Abstract

BackgroundLength of hospital stay (LOS) may serve as a surrogate measure of healthcare quality and resource use, particularly when transfers of care and readmissions are accounted for. This study aimed to benchmark true hospital stay by measuring index, transfer and readmission stays across the range of digestive cancer surgery.MethodsA cohort study of all patients undergoing resection for cancer of the oesophagus, stomach, liver, pancreas, colon or rectum in 2012–2016 was undertaken. Index LOS, transfer and readmission stays were merged into an ‘aggregated’ length of stay (a‐LOS), and compared between organ sites and between open and minimal‐access approaches.ResultsIn total, 24 354 resections were reported (mean age of patients 68·3 years; 51·3 per cent were men). Resections were reported as laparoscopic for 9151 procedures (37·6 per cent), with a further 283 (3·0 per cent) described as converted to open surgery. Use of a‐LOS compared with standard LOS added a median of 5 days for pancreatoduodenectomy, 4 days for major liver resections, 3 days for oesophageal and gastric resections, and 2 days for minor liver, distal pancreatic and rectal resections.ConclusionOverall hospital stay across organ sites and procedures is better described by a‐LOS. The study benchmarks the use of total hospital days during the first 30 days in a universal healthcare system.

Benchmarking of abdominal surgery: a study evaluating the HARM score in a European national cohort

“…Although it could be useful for risk adjustment, this study did not measure the severity of illness or the complexity and duration of the surgery. A recent Norwegian study of gastrointestinal cancer surgery concluded that an appropriate measure of LOS should include not only transfers, but also readmissions.…”

Variation in use of open and laparoscopic distal pancreatectomy and associated outcome metrics in a universal health care system

“…This was a longitudinal, observational national 5-year cohort study covering the universal health care system in Norway (from 1.1.2012 to 31.12.2016), as described in detail previously for nationwide data and time-trends [7,8,10] and consulting the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology in Epidemiology (STROBE) [11].…”

“…The details of the inclusion and exclusion criteria have been presented previously [7,10]. Briefly, all Norwegian hospitals must submit data to the Norwegian Patient Registry (NPR) for registry and reimbursement purposes.…”

“…The selected NPR variables have good data quality and high completeness [12]. A more detailed description of data capture and coding retrieval have been described previously [10], and reported for pan-creatoduodenectomy [8] and distal pancreatic resections [7] in a nationwide perspective. Operations were identified from the Nordic Medico-Statistical Committee (NOMESCO) Classification of Surgical Procedures (NCSP), version 2014 [13], with codes for open (JLC10) and laparoscopic (JLC11) distal pancreatectomy with or without inclusion of splenectomy code (open or laparoscopic; JMA10 or JMA11).…”

“…Notably, hospital stay is possible to monitor after discharge across health trusts and other hospitals by coupling the unique patient identifier with any subsequent stay at any Norwegian hospital with an admission date within 30 days from the index procedure. Hospital stay was reported as described in detail previously [10] using as an aggregated length of stay (aLoS). An aLoS was counted as the total (cumulative) number of nights spent in any hospital within the first 30 days from an index operation; index stay, pluss any transfer or readmissions within the same 30-day period.…”