EP404 - Factors Impacting Length of Stay for Patients Undergoing Colon Resections: A Multicenter Retrospective Analysis

Purpose/Background: Length of stay (LOS) following major colon resection is a critical metric that impacts patient outcomes, healthcare resource utilization, and overall costs. This variable can be affected by surgical site infections, age, need for reoperation, as well as patient comorbidities. Prior studies have not demonstrated a difference in LOS due to gender. Understanding discrepancies can help to improve patient care, optimize surgical outcomes, and enhance healthcare efficiency. We sought to identify any factors that impact hospital LOS following a major colon or small bowel resection procedure, limiting our study population to patients with only the comorbidities of diabetes or hypertension in order to decrease discrepancies in LOS as related to other comorbid conditions.

Methods/Interventions: We utilized the HCA Healthcare Data Warehouse (EDW) across multiple hospitals nationwide to evaluate adults 18 to 90 years of age who underwent small bowel or colon resection with primary anastomosis from January 2020 to December 2023. Exclusion criteria included: patients less than 18 years of age or greater than 89 years of age, and any history of stroke, cardiac arrest or heart failure. Chi-squared test was used to determine if age, gender, BMI, white blood cell count, albumin, hemoglobin or height had a strong association with the hospital length of stay.

Results/Outcomes: A total of 2,408 patients were identified initially; after excluding those with history of stroke, cardiac arrest, or heart failure as well as those patients with no labs available for analysis, we were left with 1,271 patients for inclusion in the study. Assuming all other variables in the model are held constant, the LOS was expected to be 0.998 times greater for every 1-year increase in age (IRR = 0.998, 95% CI 0.995-0.999, p< 0.05), 1.203 times greater for male patients as compared to female patients (IRR 1.203, 95% CI 1.117-1.296, p< 0.05), and be 0.896 times greater for handsewn anastomosis as compared to stapled anastomosis (IRR = 0.896, 95% CI 0.835-0.962, p< 0.05). the mean hemoglobin was 10.91 (SD +/- 1.87, IQR 2.95), the mean WBC was 10.62 (SD +/- 3.47, IQR 4.56), and the mean albumin was 2.71 (SD +/- 0.70, IQR 1.00) for the study population. The LOS was expected to be 0.885 times greater for every 1-point increase in hemoglobin (IRR 0.885, 95% CI 0.865-0.906, p< 0.05), 1.209 times greater for every 1-point increase in WBC (IRR 1.209, 95% CI 1.018-1.041, p< 0.05), and 0.634 times greater for every 1-point increase in albumin (IRR 0.634, 95% CI 0.597-0.673, p< 0.05).

Conclusion/Discussion: In our study, patient age, gender, and nutritional status were key determinants of LOS, in patients with limited comorbidities hospitalized for colon resections. As patients with average or higher than average albumin levels had decreased LOS, implementing targeted nutritional interventions, such as preoperative optimization or early oral nutritional supplementation, may help to decrease LOS. Our findings provide valuable insights for surgeons, hospital administrators, and policymakers in developing targeted strategies to reduce LOS while maintaining high-quality care for patients undergoing major colon resection. The gender disparity in LOS, with male patients experiencing longer LOS, could be the result of potential variations in pain perception, recovery patterns, or other physiological factors (i.e. visceral obesity versus subcutaneous obesity) between males and females; further research is needed in this area to better understand the clinical implications.

Exam Findings of Anorectal Clinic Visit Patients
Figure 1 depicts the relationship between common anorectal exam findings observed in patients in this cohort and whether their referral reason included (dark grey) or did not include (light grey) this diagnosis.