Predictors of a Long Hospital Stay After Abdominoperineal Resection of Rectal Cancer: Analysis of the National Cancer Database

Background It is difficult to predict which patients will have longer postoperative hospital stays after rectal cancer surgery. We aimed to determine the predictors of a long hospital stay following abdominoperineal resection (APR) for rectal cancer. Methods Retrospective cohort analysis of patients diagnosed with rectal adenocarcinoma in the National Cancer Database between 2015 and 2019 with clinical stage I-IV cancers who underwent APR. Multiple linear regression analysis was conducted to determine the predictors of a long hospital stay. A statistical calculator was created to predict the in-hospital length of stay. Results 7470 patients (63.2% males; mean age: 62.3 years) were included. Median hospital stay was 6 (IQR: 4-8) days. Black patients stayed nearly two days longer compared to other patients (1.9; 95% CI: 1.33-2.49, P < 0.001). Patients with a Charlson Deyo Score of 3 also had a longer length of stay (1.96, 95% CI: 1.02-2.91, P < .001). Robotic surgery was associated with shorter hospital stays (−0.7 days, 95% CI - 1.1, −0.4, P < .001), while conversion from minimally invasive to open surgery was associated with a longer hospital stay (1.1 days, 95% CI: 0.55-1.68, P < .001). Conclusion Older age, black race, male sex, and severe comorbidities were associated with longer hospital stays, while minimally invasive surgery was associated with decreased length of stay.