Post-operative Anaemia Independently Predicts Prolonged Hospital Length of Stay After Upper Gastrointestinal Cancer Surgery

Abstract

Abstract Background Prolonged hospital length of stay (LOS) after major surgery is associated with increased mortality rates, readmissions, and postoperative complications, adversely affecting functional recovery. To address this issue and optimize resource allocation, we conducted a retrospective cohort study focusing on elective upper gastrointestinal cancer surgeries. Methods Observational retrospective cohort study of all patients who underwent various upper gastrointestinal cancer procedures at a major tertiary hospital in 2021. Data were extracted from a prospective database. Pre-, intra-, and post-operative factors were collected. Patients were dichotomized into expected LOS and prolonged LOS. Results 111 patients were analyzed. The average age was 64.0 years and 36.9% underwent a Whipple’s procedure. 23.4% of the patients had prolonged hospital LOS. Patients with longer hospital LOS had no neoadjuvant radiation therapy (84.6% vs 82.4%, p = 0.016), more readmission to the theatre (34.6% vs 7.1%, p = 0.001), more unplanned ICU admissions (15.4% vs 2.4%, p = 0.023), longer ICU admissions (76.9% vs 74.1%, p = 0.012), lower intra-op Hb (106.5 ± 17.9 vs 115.8 ± 17.0, p = 0.021), lower day 1 post-op Hb (100.1 ± 17.3 vs 111.7 ± 15.7, p = 0.002), lower 1st -week nadir Hb (89.3 ± 17.0 vs 104.9 ± 16.6, p < 0.001) and more post-op transfusion requirements (23.1% vs 5.9%, p = 0.019). Univariate analysis identified several significant predictors of prolonged hospital LOS, including unplanned ICU admission, readmission to theatre, lowest intra-op Hb, lowest day 1 post-op Hb and 1st week Hb nadir. Multivariate analysis adjusting for unplanned ICU admission (OR = 6.80, CI 1.03-45.00, p = 0.047) and readmission to theatre (OR 8.48, CI 2.40–30.00, p = 0.001) revealed that lower Hb levels (OR 0.95, CI 0.92–0.98, p = 0.002) were associated with prolonged hospital LOS. Conclusion Post-operative anemia, unplanned return to theatre and unplanned ICU admission are significant factors contributing to extended hospital stays. Addressing post-operative anemia may effectively reduce hospital LOS.