eP366 - Predictors of a Long Hospital Stay After Abdominoperineal Resection of Rectal Cancer - Analysis of the National Cancer Database

ePoster Presenter(s)

• 

  Ashley Shustak, MD

  Clinical Fellow
  Cleveland Clinic Florida
  Cleveland Clinic Florida
  Weston, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• MO

  Marcus Oosenbrug, MD (he/him/his)

  Clinical Fellow
  Cleveland Clinic Florida
  Cleveland Clinic Florida
  Weston, FL, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Nir Horesh, MD

  Clinical Fellow
  Cleveland Clinic Florida
  Cleveland Clinic Florida
  Weston, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Sameh Hany Emile, MBBCh, MSc, MD/PhD

  Project Scientist
  Cleveland Clinic Florida
  Cleveland Clinic Florida
  Weston, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Zoe Garoufalia, MD (she/her/hers)

  Clinical Fellow
  Cleveland Clinic Florida
  Cleveland Clinic Florida
  Weston, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• ES

  Ebram Salama, MD

  Clinical Associate - Colorectal Surgery
  Cleveland Clinic Florida
  Weston, Florida, United States

  Disclosure information not submitted.
• SS

  Stephen Sharp, MD, FACS

  Assistant Professor of Surgery
  Virginia Commonwealth University
  Richmond, Virginia, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Steven D. Wexner, MD, PhD (Hon)

  Chairman
  Cleveland Clinic Florida
  Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
  Weston, Florida, United States

  Disclosure information not submitted.

Purpose/Background: The length of hospital stay after colon and rectal surgery may vary. It is often difficult to predict which patients will have longer postoperative hospital stays after rectal cancer surgery. We aimed to determine the predictors of a long hospital stay after Abdominoperineal Resection (APR) in patients with rectal cancer using the US National Cancer Database (NCDB).Methods/Interventions: A retrospective cohort analysis of all patients with stage I-IV rectal cancer undergoing APR included in the NCDB between 2015 and 2019 was performed. A multiple linear regression analysis was conducted to determine the predictors of a long hospital stay. A receiver operating characteristics (ROC) curve analysis was done to estimate the cutoff number of days of hospital stay that signified worse overall survival. Kaplan-Meier statistics were used to assess the association between long hospital stays and overall survival.Results/Outcomes: A total of 7,470 patients (63.2% Males) were included, with a mean age of 62.3 years. The majority of patients were white (85.4%) had had private insurance (43.5%) or Medicare (42.5%). 74.5% of patients had minimal or no comorbidities (Charlson Deyo Score 0). Minimally invasive surgery accounted for most procedures performed (robotic: 34.6% and laparoscopic: 24.6%). 45% of patients had stage III disease and 76% received neoadjuvant chemoradiation therapy. The median hospital stay was 6 (IQR: 4-8) days. Older patients had increased hospital stay: for every 10 years increase in age there was an increase of stay by 0.3 days (CI: 0.2-0.5, p < 0.001). Male patients stayed 0.5 days longer than females (CI: 0.17-0.85, p=0.003). Black patients stayed nearly two days longer than patients of any other races (1.9; CI: 1.33-2.49, p < 0.001). Patients with Charlson Deyo Score of 3 stayed in the hospital longer (1.96, CI: 1.02-2.91, p < 0.001). Compared to patients with Medicaid insurance, patients with private insurance stayed had a shorter hospital day (-1.5 days, CI: -1.75, -0.53, p < 0.001). A robotic approach was associated with shorter hospital stays (-0.7 days, CI -1.1, -0.4, p < 0.001), while conversion to open surgery was associated with longer hospital stays (1.1 days, CI: 0.55-1.68, p < 0.001). Facility type, cancer stage, and time to definitive surgery were not significantly associated with hospital stay. Using ROC curve analysis, 6 days was the cutoff number that signified worse overall survival. Patients with hospital stays ≥6 days had shorter overall survival (73 vs. 75 months, p < 0.001) than patients with stays < 6 days; however, the clinical significance of this difference is unclear.Conclusion/

Discussion: Our findings show that older, Black, male patients with more comorbidities and Medicaid insurance have longer hospital stays. The reason for a longer stay is multifaceted and requires further research. Importantly, patients at increased risk of a longer stay may benefit from prehabilitation and targeted preoperative interventions to try to decrease hospital stay, improve outcomes, and reduce costs to the medical system.Figure.Overall survival after APR for rectal cancer based on length of hospital stay