Decreasing length of stay after pancreatoduodenectomy

A. D. Brooks, S. G. Marcus, C. Gradek, E. Newman, Peter Shamamian, T. H. Gouge, H. L. Pachter, K. Eng

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Hypothesis: Decreased length of stay (LOS) after pancreatoduodenectomy is due to multiple factors, including a lower complication rate and more efficient perioperative care for all patients, with and without complications. Design: A retrospective review, validation cohort. Setting: A single university hospital referral center. Patients: A consecutive sample of patients undergoing pancreatoduodenectomy from January 9, 1986, to December 21, 1992 (group 1 [n = 104]) and from February 16, 1993, to November 9, 1998 (group 2 [n = 111]). Intervention: Mann-Whitney test and logistic regression analysis applied to clinical variables and LOS. Main Outcome Measures: Difference in median LOS between early and late groups and identification of factors predictive of decreased LOS. Results: Total LOS decreased between the 2 groups (26 days [range, 13-117 days] vs 15 days [range, 5-61 days]; P<.001), with a decrease in preoperative (4 days [range, 0-28 days] vs 2 days [range, 0-36 days]; P<.001) and postoperative (19 days [range, 11-95 days] vs 12 days [range, 4-58 days]; P<.001) LOS (data given for group 1 vs group 2). Major complications decreased from 49% in group 1 to 25% in group 2 (P<.001). Postoperative LOS decreased for patients with (25 days [range, 15-95 days] vs 20 days [range, 8-58 days]; P = .05) and without (15 days [range, 11-47 days] vs 11 days [range, 4-55 days]; P<.001) major complications (data given for group 1 vs group 2). Multivariate analysis identified age (P = .01), pancreatic fistula (P<.001), delayed gastric emptying (P<.001), biliary complications (P<.001), operative time (P<.005), extra-abdominal infection (P<.005), use of a percutaneous stent (P = .04), and year of operation (P<.001) as independent predictors of total LOS. Conclusion: A reduction in complications in combination with factors leading to a streamlining of perioperative care has contributed to the decreased LOS after pancreatoduodenectomy.

Original languageEnglish (US)
Pages (from-to)823-830
Number of pages8
JournalArchives of Surgery
Volume135
Issue number7
StatePublished - 2000
Externally publishedYes

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Pancreaticoduodenectomy
Length of Stay
Perioperative Care
Pancreatic Fistula
Social Identification
Gastric Emptying
Operative Time
Stents
Referral and Consultation
Multivariate Analysis
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

Brooks, A. D., Marcus, S. G., Gradek, C., Newman, E., Shamamian, P., Gouge, T. H., ... Eng, K. (2000). Decreasing length of stay after pancreatoduodenectomy. Archives of Surgery, 135(7), 823-830.

Decreasing length of stay after pancreatoduodenectomy. / Brooks, A. D.; Marcus, S. G.; Gradek, C.; Newman, E.; Shamamian, Peter; Gouge, T. H.; Pachter, H. L.; Eng, K.

In: Archives of Surgery, Vol. 135, No. 7, 2000, p. 823-830.

Research output: Contribution to journalArticle

Brooks, AD, Marcus, SG, Gradek, C, Newman, E, Shamamian, P, Gouge, TH, Pachter, HL & Eng, K 2000, 'Decreasing length of stay after pancreatoduodenectomy', Archives of Surgery, vol. 135, no. 7, pp. 823-830.
Brooks AD, Marcus SG, Gradek C, Newman E, Shamamian P, Gouge TH et al. Decreasing length of stay after pancreatoduodenectomy. Archives of Surgery. 2000;135(7):823-830.
Brooks, A. D. ; Marcus, S. G. ; Gradek, C. ; Newman, E. ; Shamamian, Peter ; Gouge, T. H. ; Pachter, H. L. ; Eng, K. / Decreasing length of stay after pancreatoduodenectomy. In: Archives of Surgery. 2000 ; Vol. 135, No. 7. pp. 823-830.
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abstract = "Hypothesis: Decreased length of stay (LOS) after pancreatoduodenectomy is due to multiple factors, including a lower complication rate and more efficient perioperative care for all patients, with and without complications. Design: A retrospective review, validation cohort. Setting: A single university hospital referral center. Patients: A consecutive sample of patients undergoing pancreatoduodenectomy from January 9, 1986, to December 21, 1992 (group 1 [n = 104]) and from February 16, 1993, to November 9, 1998 (group 2 [n = 111]). Intervention: Mann-Whitney test and logistic regression analysis applied to clinical variables and LOS. Main Outcome Measures: Difference in median LOS between early and late groups and identification of factors predictive of decreased LOS. Results: Total LOS decreased between the 2 groups (26 days [range, 13-117 days] vs 15 days [range, 5-61 days]; P<.001), with a decrease in preoperative (4 days [range, 0-28 days] vs 2 days [range, 0-36 days]; P<.001) and postoperative (19 days [range, 11-95 days] vs 12 days [range, 4-58 days]; P<.001) LOS (data given for group 1 vs group 2). Major complications decreased from 49{\%} in group 1 to 25{\%} in group 2 (P<.001). Postoperative LOS decreased for patients with (25 days [range, 15-95 days] vs 20 days [range, 8-58 days]; P = .05) and without (15 days [range, 11-47 days] vs 11 days [range, 4-55 days]; P<.001) major complications (data given for group 1 vs group 2). Multivariate analysis identified age (P = .01), pancreatic fistula (P<.001), delayed gastric emptying (P<.001), biliary complications (P<.001), operative time (P<.005), extra-abdominal infection (P<.005), use of a percutaneous stent (P = .04), and year of operation (P<.001) as independent predictors of total LOS. Conclusion: A reduction in complications in combination with factors leading to a streamlining of perioperative care has contributed to the decreased LOS after pancreatoduodenectomy.",
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T1 - Decreasing length of stay after pancreatoduodenectomy

AU - Brooks, A. D.

AU - Marcus, S. G.

AU - Gradek, C.

AU - Newman, E.

AU - Shamamian, Peter

AU - Gouge, T. H.

AU - Pachter, H. L.

AU - Eng, K.

PY - 2000

Y1 - 2000

N2 - Hypothesis: Decreased length of stay (LOS) after pancreatoduodenectomy is due to multiple factors, including a lower complication rate and more efficient perioperative care for all patients, with and without complications. Design: A retrospective review, validation cohort. Setting: A single university hospital referral center. Patients: A consecutive sample of patients undergoing pancreatoduodenectomy from January 9, 1986, to December 21, 1992 (group 1 [n = 104]) and from February 16, 1993, to November 9, 1998 (group 2 [n = 111]). Intervention: Mann-Whitney test and logistic regression analysis applied to clinical variables and LOS. Main Outcome Measures: Difference in median LOS between early and late groups and identification of factors predictive of decreased LOS. Results: Total LOS decreased between the 2 groups (26 days [range, 13-117 days] vs 15 days [range, 5-61 days]; P<.001), with a decrease in preoperative (4 days [range, 0-28 days] vs 2 days [range, 0-36 days]; P<.001) and postoperative (19 days [range, 11-95 days] vs 12 days [range, 4-58 days]; P<.001) LOS (data given for group 1 vs group 2). Major complications decreased from 49% in group 1 to 25% in group 2 (P<.001). Postoperative LOS decreased for patients with (25 days [range, 15-95 days] vs 20 days [range, 8-58 days]; P = .05) and without (15 days [range, 11-47 days] vs 11 days [range, 4-55 days]; P<.001) major complications (data given for group 1 vs group 2). Multivariate analysis identified age (P = .01), pancreatic fistula (P<.001), delayed gastric emptying (P<.001), biliary complications (P<.001), operative time (P<.005), extra-abdominal infection (P<.005), use of a percutaneous stent (P = .04), and year of operation (P<.001) as independent predictors of total LOS. Conclusion: A reduction in complications in combination with factors leading to a streamlining of perioperative care has contributed to the decreased LOS after pancreatoduodenectomy.

AB - Hypothesis: Decreased length of stay (LOS) after pancreatoduodenectomy is due to multiple factors, including a lower complication rate and more efficient perioperative care for all patients, with and without complications. Design: A retrospective review, validation cohort. Setting: A single university hospital referral center. Patients: A consecutive sample of patients undergoing pancreatoduodenectomy from January 9, 1986, to December 21, 1992 (group 1 [n = 104]) and from February 16, 1993, to November 9, 1998 (group 2 [n = 111]). Intervention: Mann-Whitney test and logistic regression analysis applied to clinical variables and LOS. Main Outcome Measures: Difference in median LOS between early and late groups and identification of factors predictive of decreased LOS. Results: Total LOS decreased between the 2 groups (26 days [range, 13-117 days] vs 15 days [range, 5-61 days]; P<.001), with a decrease in preoperative (4 days [range, 0-28 days] vs 2 days [range, 0-36 days]; P<.001) and postoperative (19 days [range, 11-95 days] vs 12 days [range, 4-58 days]; P<.001) LOS (data given for group 1 vs group 2). Major complications decreased from 49% in group 1 to 25% in group 2 (P<.001). Postoperative LOS decreased for patients with (25 days [range, 15-95 days] vs 20 days [range, 8-58 days]; P = .05) and without (15 days [range, 11-47 days] vs 11 days [range, 4-55 days]; P<.001) major complications (data given for group 1 vs group 2). Multivariate analysis identified age (P = .01), pancreatic fistula (P<.001), delayed gastric emptying (P<.001), biliary complications (P<.001), operative time (P<.005), extra-abdominal infection (P<.005), use of a percutaneous stent (P = .04), and year of operation (P<.001) as independent predictors of total LOS. Conclusion: A reduction in complications in combination with factors leading to a streamlining of perioperative care has contributed to the decreased LOS after pancreatoduodenectomy.

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