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Background <p>It is common to observe a gap between the day on which the discharge criteria are reached and the actual day of discharge after colorectal surgery. The aim of this study is to understand the reasons for this difference and its clinical impact on the overall length of stay (LOS).</p> Methods <p>All patients enrolled in the prospective iCral3 study were analyzed regarding any difference and reason between the “fit for discharge” (FFD) and “actual discharge” (AD) dates. The association between the gap and the LOS in the whole population was then assessed through a multivariate regression model including other confounding variables.</p> Results <p>The analysis included 4529 patients, with a median [IQR] LOS of 6 [4–8] days. The median [IQR] LOS was 6 [4–8] days in the no-gap group (3,910 patients, 86.3%), significantly lower (<i>p</i> &lt; .001) than 7 [6–10] days in the gap group (619 patients, 13.7%). Among the gap reasons, the “need for postoperative rehabilitation” compared to “not willing to return home” and “social constraints” was associated with the longest LOS (9 [6.0–12.5] days, <i>p</i> &lt; 0.001 vs other reasons). The existence of the gap independently determined a 2.3-day lengthening of LOS.</p> Conclusions <p>Among other factors, the gap between FFD and AD had an independent impact on LOS. The most frequent reasons for this gap were “not willing to return home” and “social constraint”, while the “need for postoperative rehabilitation” had the greater clinical impact.</p>

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Length of stay after colorectal surgery in Italy: the gap between “fit for” and “actual” discharge in a prospective cohort of 4529 cases

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  • 发表日期：

    2025年2月4日

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  • Lorenzo Pandolfini,
  • Duccio Conti,
  • Piercarlo Ballo,
  • Silvia Rollo,
  • Alessandro Falsetto,
  • Gian Matteo Paroli,
  • Paolo Ciano,
  • Michele Benedetti,
  • Leonardo Antonio Montemurro,
  • Giacomo Ruffo,
  • Massimo Giuseppe Viola,
  • Felice Borghi,
  • Gianandrea Baldazzi,
  • Massimo Basti,
  • Pierluigi Marini,
  • Mariano Fortunato Armellino,
  • Vincenzo Bottino,
  • Giovanni Ciaccio,
  • Alessandro Carrara,
  • Gianluca Guercioni,
  • Marco Scatizzi,
  • Marco Catarci,
  • Maria Sole Mattei,
  • Elena Belloni,
  • Daniela Apa,
  • Matteo Di Carlo,
  • Grazia Maria Attinà,
  • Elisa Bertocchi,
  • Gaia Masini,
  • Amedeo Altamura,
  • Francesco Rubichi,
  • Ferdinando Ficari,
  • Francesco Giudici,
  • Fabio Cianchi,
  • Paolo Delrio,
  • Ugo Pace,
  • Andrea Fares Bucci,
  • Felice Pirozzi,
  • Antonio Sciuto,
  • Desirée Cianflocca,
  • Marco Migliore,
  • Raffaele De Luca,
  • Michele Simone,
  • Alberto Patriti,
  • Marcella Ricci,
  • Gianluca Garulli,
  • Mattia Portinari,
  • Walter Siquini,
  • Alessandro Cardinali,
  • Massimo Sartelli,
  • Stefano D’Ugo,
  • Marcello Spampinato,
  • Stefano Scabini,
  • Alessandra Aprile,
  • Domenico Soriero,
  • Giusto Pignata,
  • Jacopo Andreuccetti,
  • Ilaria Canfora,
  • Andrea Liverani,
  • Andrea Scarinci,
  • Roberto Campagnacci,
  • Angela Maurizi,
  • Ugo Elmore,
  • Giulia Maggi,
  • Francesco Corcione,
  • Umberto Bracale,
  • Roberto Peltrini,
  • Roberto Santoro,
  • Pietro Maria Amodio,
  • Massimo Carlini,
  • Domenico Spoletini,
  • Rosa Marcellinaro,
  • Antonio Giuliani,
  • Giovanni Del Vecchio,
  • Mario Sorrentino,
  • Massimo Stefanoni,
  • Giovanni Ferrari,
  • Carmelo Magistro,
  • Diletta Cassini,
  • Alberto Di Leo,
  • Lorenzo Crepaz,
  • Augusto Verzelli,
  • Andrea Budassi,
  • Giuseppe Sica,
  • Bruno Sensi,
  • Stefano Rausei,
  • Silvia Tenconi,
  • Davide Cavaliere,
  • Leonardo Solaini,
  • Giorgio Ercolani,
  • Gian Luca Baiocchi,
  • Sarah Molfino,
  • Marco Milone,
  • Giovanni Domenico De Palma,
  • Paolo Locurto,
  • Giovanni Domenico Tebala,
  • Antonio Di Cintio,
  • Luigi Boni,
  • Elisa Cassinotti,
  • Stefano Mancini,
  • Andrea Sagnotta,
  • Roberto Persiani,
  • Alberto Biondi,
  • Andrea Lucchi,
  • Giacomo Martorelli,
  • Dario Parini,
  • Maurizio De Luca,
  • Michele Genna,
  • Francesca Fior,
  • Antonio Ferronetti,
  • Andrea Coratti,
  • Giuseppe Giuliani,
  • Roberto Benigni,
  • Dario Scala,
  • Graziella Marino,
  • Andrea Muratore,
  • Patrizia Marsanic,
  • Maurizio,
  • Carlo Di Marco,
  • Umberto Rivolta,
  • Micaela Piccoli,
  • Francesca Pecchini,
  • Carlo Talarico,
  • Vincenzo Greco,
  • Giuseppe Tirone,
  • Michele Motter,
  • Stefano Guadagni,
  • Marco Clementi,
  • Franco Roviello,
  • Riccardo Piagnerelli,
  • Giuseppe Maria Ettorre,
  • Marco Colasanti,
  • Mauro Montuori,
  • Enrico Pinotti,
  • Pierpaolo Mariani,
  • Roberta Carminati,
  • Nicolò de Manzini,
  • Edoardo Osenda,
  • Annibale Donini,
  • Luigina Graziosi,
  • Ciro De Martino,
  • Lucio Taglietti,
  • Silvia ruggiero,
  • Gabriele Anania,
  • Matteo Chiozza,
  • Mariantonietta Di Cosmo,
  • Daniele Zigiotto,
  • Carlo Vittorio Feo,
  • Fioralba Pindozzi,
  • Paolo Millo,
  • Manuela Grivon,
  • Corrado Pedrazzani,
  • Cristian Conti,
  • Silvio Guerriero,
  • Lorenzo Organetti,
  • Federico Marchesi,
  • Giorgio Dalmonte,
  • Diletta Frazzini,
  • Graziano Longo,
  • Simone Santoni,
  • Moreno Cicetti,
  • Gabriele La Gioia

摘要

Background

It is common to observe a gap between the day on which the discharge criteria are reached and the actual day of discharge after colorectal surgery. The aim of this study is to understand the reasons for this difference and its clinical impact on the overall length of stay (LOS).

Methods

All patients enrolled in the prospective iCral3 study were analyzed regarding any difference and reason between the “fit for discharge” (FFD) and “actual discharge” (AD) dates. The association between the gap and the LOS in the whole population was then assessed through a multivariate regression model including other confounding variables.

Results

The analysis included 4529 patients, with a median [IQR] LOS of 6 [4–8] days. The median [IQR] LOS was 6 [4–8] days in the no-gap group (3,910 patients, 86.3%), significantly lower (p < .001) than 7 [6–10] days in the gap group (619 patients, 13.7%). Among the gap reasons, the “need for postoperative rehabilitation” compared to “not willing to return home” and “social constraints” was associated with the longest LOS (9 [6.0–12.5] days, p < 0.001 vs other reasons). The existence of the gap independently determined a 2.3-day lengthening of LOS.

Conclusions

Among other factors, the gap between FFD and AD had an independent impact on LOS. The most frequent reasons for this gap were “not willing to return home” and “social constraint”, while the “need for postoperative rehabilitation” had the greater clinical impact.