Safe Discharge Criteria After Curative Gastrectomy for Gastric Cancer

Abstract

Purpose: This study aimed to investigate the relationship between clinical and laboratory parameters and complication status to predict which patients can be safely discharged from the hospital on the third postoperative day (POD). Materials and Methods: Data from a prospectively maintained database of 2,110 consecutive patients with gastric adenocarcinoma who underwent curative surgery were reviewed. The third POD vital signs, laboratory data, and details of the course after surgery were collected. Patients with grade II or higher complications after the third POD were considered unsuitable for early discharge. The performance metrics were calculated for all algorithm parameters. The proposed algorithm was tested using a validation dataset of consecutive patients from the same center. Results: Of 1,438 patients in the study cohort, 142 (9.9%) were considered unsuitable for early discharge. C-reactive protein level, body temperature, pulse rate, and neutrophil count had good performance metrics and were determined to be independent prognostic factors. An algorithm consisting of these 4 parameters had a negative predictive value (NPV) of 95.9% (95% confidence interval [CI], 94.2-97.3), sensitivity of 80.3% (95% CI, 72.8-86.5), and specificity of 51.1% (95% CI,). Only 28 (1.9%) patients in the study cohort were classified as false negatives. In the validation dataset, the NPV was 93.7%, sensitivity was 66%, and 3.3% (17/512) of patients were classified as false negatives. Conclusions: Simple clinical and laboratory parameters obtained on the third POD can be used when making decisions regarding the safe early discharge of patients who underwent gastrectomy.

Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the da Vinci Single Port(SP) robotic system

“…Regardless of gas passing, a liquid diet was followed from the morning of the first postoperative day, followed by a soft diet at noon and evening. If there were no specific complications until postoperative day 3, discharge was encouraged if the patient’s condition satisfied the previously reported safe discharge criteria 33 .…”

“…In all 19 patients, a soft diet was possible at maximum 2 days after surgery, and gas passing was confirmed as evidence of bowel movement recovery after a mean of www.nature.com/scientificreports/ 2.1 days (range 1-3 days). According to the discharge criteria protocol 33 , all patients were discharged after a mean of 3.2 days (range 2-4 days) of postoperative hospital stay. There were no early postoperative major complications of Clavien-Dindo classification grade III or higher.…”

Fluorescence-guided Two-port Robotic Gastrectomy Versus Conventional Laparoscopic Gastrectomy: A Nonrandomized Controlled Trial

“…When no clinical signs of complications, infection, or inflammation were observed, the patients were discharged from the hospital. 18 Especially, the laboratory parameters including C-reactive protein, body temperature, pulse rate, and neutrophil count on POD 3 were used in the decision-making criteria for discharge after gastrectomy for gastric cancer. Postoperative complications were categorized based on the Clavien-Dindo classification.…”