Length of Hospital Stay in Patients with Primary Liver Cancer Undergoing Surgery: Risk Factors and Predictive Model Development

Bin Sun,1 Xiaobo Li,2 Xiuying He,1 Na Zhang3 1Department of the International Special Needs Ward, First Hospital of China Medical University, Shenyang, Liaoning, 110001, People’s Republic of China; 2Nursing Department, First Hospital of China Medical University, Shenyang, Liaoning, 110001, People’s Republic of China; 3Department of Hepatobiliary Surgery, First Hospital of China Medical University, Shenyang, Liaoning, 110001, People’s Republic of ChinaCorrespondence: Xiuying He, Email [email protected] Na Zhang, Email [email protected]: To identify preoperative risk factors for prolonged length of hospital stay (LOS) in patients undergoing surgery for primary liver cancer and to develop a predictive nomogram.Methods: We retrospectively analyzed 702 surgical patients from a single center (2020– 2023). LOS was modeled using negative binomial regression based on preoperative factors to construct a nomogram. Model performance was evaluated via internal bootstrap validation (1000 resamples), calibration plots, and decision curve analysis. Prolonged LOS was defined as > 17 days (75th percentile) for a secondary logistic regression analysis.Results: Four independent preoperative factors predicted longer LOS: lower serum cholinesterase, higher fibrinogen, intrahepatic cholangiocarcinoma (vs hepatocellular carcinoma), and female sex (all p< 0.05). The nomogram showed moderate discriminative ability (apparent AUC ~0.67) with good calibration. The mean absolute error for LOS prediction was ~4.6 days. For predicting prolonged LOS (> 17 days), the logistic model achieved an AUC of ~0.67.Conclusion: We developed an internally validated nomogram using routine preoperative data to estimate the risk of extended hospitalization after liver cancer surgery. This tool may help identify high-risk patients for targeted interventions, although its predictive accuracy is modest, and external validation is required before clinical application.Keywords: length of stay, liver cancer, nomogram, nursing, surgery