Association of postoperative anaemia with prolonged hospital length of stay after upper gastrointestinal cancer surgery: a single-centre retrospective cohort study✰

Background Prolonged hospital length of stay (LOS) after major upper gastrointestinal (GI) cancer surgery is associated with increased morbidity, mortality, and healthcare costs. Perioperative anaemia is common in this population. This study examined whether reduced haemoglobin (Hb) is independently associated with prolonged LOS after elective upper GI cancer surgery. Methods We conducted a retrospective observational cohort study of patients undergoing elective upper GI cancer surgery at a tertiary hospital in Western Australia. Pre-, intra-, and postoperative data were obtained from a prospective institutional database. Patients were dichotomised into expected-LOS and prolonged-LOS groups based on the procedure-specific median LOS. Multivariable logistic regression was used to identify factors independently associated with prolonged LOS. Results A total of 111 patients were included; 26 (23.4%) had prolonged LOS. These patients had lower Hb intraoperatively (106.5±17.9 vs 115.8±17.0 g L −1 ; P =0.021), on postoperative day 1 (100.1±17.3 vs 111.7±15.7 g L −1 ; P =0.002), and at first-week nadir (89.3±17.0 vs 104.9±16.6 g L −1 ; P <0.001). Reoperation (34.6% vs 7.1%; P =0.001) and unplanned ICU admission (15.4% vs 2.4%; P =0.023) were more frequent. After adjustment for these factors, a lower postoperative Hb concentration remained independently associated with a prolonged LOS. The first-week Hb nadir showed the strongest association (odds ratio 0.95 per g L −1 ; 95% confidence interval 0.92–0.98; P =0.002). Conclusions Postoperative Hb decline is independently associated with prolonged LOS after elective upper GI cancer surgery. These findings support prospective evaluation of patient blood management strategies in this population.