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Identification of candidates for early discharge after gastrectomy

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Author(s)
Ji-Ho ParkYoung-Gil SonTae-Han KimYeon-Ju HuhYong-Joon SuhYun-Suhk SuhSeong-Ho KongHyuk-Joon LeeHan-Kwang YangJun-Young Yang
Keimyung Author(s)
Son, Young Gil
Department
Dept. of Surgery (외과학)
Journal Title
Annals of Surgical Oncology
Issued Date
2017
Volume
24
Issue
1
Keyword
Gastric CancerWhite Blood Cell CountEarly Gastric CancerAnastomotic StenosisLaparoscopic Gastrectomy
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.
Keimyung Author(s)(Kor)
손영길
Publisher
School of Medicine
Citation
Ji-Ho Park et al. (2017). Identification of candidates for early discharge after gastrectomy. Annals of Surgical Oncology, 24(1), 159–166. doi: 10.1245/s10434-016-5447-1
Type
Article
ISSN
1068-9265
Source
https://link.springer.com/article/10.1245%2Fs10434-016-5447-1
DOI
10.1245/s10434-016-5447-1
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32721
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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