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A simple prediction score for prolonged length of stay following elective colorectal cancer surgery

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Abstract

Background

Current enhanced recovery after surgery (ERAS) protocols are designed for all patients without tailored programmes for at-risk groups. A risk score to determine elective colorectal cancer patients at risk for prolonged length of stay (LOS) would help to identify this group for preoperative intervention.

Methods

Multivariate analysis of demographic and preoperative variables was performed to identify independent risk factors for prolonged LOS, defined as 7 days or more. A stepwise variable selection approach using logistic regression was then used to build a risk prediction model.

Results

Among 172 patients in our population, 41.9% of patients had prolonged LOS. Five variables were included in our risk prediction model. These were age ≥ 65 years (OR 13.9 5.09–38.0; p < 0.0001), neoadjuvant therapy (OR 7.60 2.51–23.0; p < 0.0001), open approach (OR 3.96 1.68–15.9); p = 0.008), history of smoking (OR 5.18 1.68–15.9; p = 0.004) and white blood cell (WBC) count (OR 0.83/unit 0.69–0.99; p = 0.040). These variables were combined to produce a score, for which the area under the receiving operator curve was 0.82 (95% CI 0.76–0.88), and Hosmer-Lemeshow test showed a χ2 statistic of 9.14 and p = 0.519. Using 0.9 as a cut-off, the score has sensitivity of 81.9% and specificity of 65.0%.

Conclusion

A simple, clinical score can be used to predict for prolonged LOS based on preoperative variables, allowing for intervention before surgery.

Article summary

Age, neoadjuvant therapy, smoking status, open approach and WBC count are independent risk factors for prolonged length of stay following elective colorectal cancer surgery. A risk score comprising the above independent variables was developed with area under the receiving operator curve of 0.82 (95% CI 0.76–0.88), and a Hosmer-Lemeshow test showing a χ2 statistic of 9.14 and p = 0.519.

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Authors and Affiliations

  1. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Dedrick Kok Hong Chan & Jia Jun Ang

  2. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Dedrick Kok Hong Chan

Authors
  1. Dedrick Kok Hong Chan
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  2. Jia Jun Ang
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Contributions

Jia Jun Ang participated in the collection of data, the analysis of data, and the drafting and final editing of the manuscript. Dedrick Kok Hong Chan participated in the writing of the manuscript, the collection of data, the analysis of data, the drafting and final editing of the manuscript and overall management of the manuscript.

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Correspondence to Dedrick Kok Hong Chan.

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The authors declare that they have no conflicts of interests.

Research involving human participants

This article does not contain any studies with human participants performed by any of the authors. This study has been approved by the National Healthcare Group Domain Specific Review Board.

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Consent from individual participants was not obtained for this study. Waiver of consent was obtained from the ethic committee due to the nature of the study.

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Chan, D.K.H., Ang, J.J. A simple prediction score for prolonged length of stay following elective colorectal cancer surgery. Langenbecks Arch Surg 406, 319–327 (2021). https://doi.org/10.1007/s00423-020-02030-7

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