Identification of candidates for early discharge after gastrectomy

Authors
Ji-Ho ParkYoung-Gil SonTae-Han KimYeon-Ju HuhYong-Joon SuhYun-Suhk SuhSeong-Ho KongHyuk-Joon LeeHan-Kwang YangJun-Young Yang
Department
Dept. of Surgery (외과학)
Issue Date
2017
Citation
Annals of Surgical Oncology, Vol.24(1) : 159-166, 2017
ISSN
1068-9265
Abstract
Objective. The aim of this study was to analyze clinical and laboratory variables associated with complications after gastrectomy for gastric cancer to predict candidates for successful early discharge. Methods. Consecutive patients undergoing gastrectomy at Seoul National University Hospital from January through December 2013 were identified from a prospective complications database. Clinicopathologic and postoperative laboratory parameters were analyzed to determine variables associated with complications. An additional validation study was performed from March through May 2014. Results. Overall, complications occurred in 180/855 patients (21.1 %). Age >68 years (odds ratio [OR] 1.64), use of an open approach (OR 1.9), and use of combined resection (OR 1.67) were significant independent risk factors for complications (p < 0.05). The postoperative day (POD) 5 to preoperative white blood cell count (WBC) ratio (risk ratio [RR] 2.01), C-reactive protein (CRP) level on POD 5 (RR 1.1), and maximum body temperature on POD 4 (RR 2.36) independently predicted complications in a multivariate analysis (p < 0.05). After establishing an early discharge profile (EDP) based on these six variables, 152/855 patients (17.8 %) were predicted to have an uncomplicated course. Of these, 8/152 (5.3 %) experienced complications. In a validation study of 217 patients, 43/217 (19.8 %) were candidates for early discharge on POD 5, and 3 (7.0 %) had a false-positive EDP. Conclusions. Patients younger than 68 years of age who underwent laparoscopic gastrectomy without combined resection might be candidates for early discharge on POD 5 if the POD 5 to preoperative WBC ratio is ≤1.2, POD 5 CRP level is ≤5.38 g/mL, and POD 4 body temperature is ≤37.4 °C.
Keywords
Gastric CancerWhite Blood Cell CountEarly Gastric CancerAnastomotic StenosisLaparoscopic Gastrectomy
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/32721
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
Keimyung Author(s)
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Full Text
https://link.springer.com/article/10.1245%2Fs10434-016-5447-1
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