PMID- 31845140 OWN - NLM STAT- MEDLINE DCOM- 20210414 LR - 20240213 IS - 1873-4626 (Electronic) IS - 1091-255X (Print) IS - 1091-255X (Linking) VI - 24 IP - 9 DP - 2020 Sep TI - Composite Length of Stay, An Outcome Measure of Postoperative and Readmission Length of Stays in Pancreatoduodenectomy. PG - 2062-2069 LID - 10.1007/s11605-019-04475-8 [doi] AB - PURPOSE: Postoperative length of stay (PLOS) and readmission rate are pancreatoduodenectomy (PD) outcome measures, which are reported individually but may be interrelated. The purpose of this study was to evaluate how well a composite length of stay measure (CLOS) that included PLOS and readmission length of stay describes outcomes. To do so, we evaluated how well CLOS correlated to postoperative complications absolutely and compared to PLOS. METHODS: A total of 668 PDs performed between 2011 and 2018 were evaluated. CLOS was calculated from PLOS and readmission length of stay. Complication severity was judged by the Modified Accordion Grading System (MAGS). Multinomial logistical regression models (MLRM) were used to investigate the relationship between either PLOS or CLOS and complications. Multilevel and pairwise area under curves (AUC) using SAS macro %MultAUC were provided for both models. RESULTS: A total of 432 of 668 patients (65%) developed complications. One hundred seventy-seven patients (27%) were readmitted. Mean PLOS was 10.2 days (7.1 SD) and mean CLOS was 12.3 days (10.1 SD). PLOS and CLOS both were correlated linearly to MAGS grade. Spearman correlation coefficient for CLOS vs. MAGS of 0.68 was higher than that of 0.49 for PLOS vs. MAGS. Multilevel AUC from MLRM using PLOS was 0.66, but multilevel AUC from MLRM using CLOS was 0.71. DISCUSSION: CLOS provides an accurate estimate of hospital day utilization per patient for PD, reflecting not only the basal hospital recovery time for PD but the added time needed because of readmissions due to complications. It is tightly correlated to number and severity of postoperative complications. FAU - Williams, Gregory A AU - Williams GA AD - Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Liu, Jingxia AU - Liu J AD - Division of Public Health Sciences, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Chapman, William C AU - Chapman WC AD - Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Hawkins, William G AU - Hawkins WG AD - Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Fields, Ryan C AU - Fields RC AD - Section of Surgical Oncology, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Sanford, Dominic E AU - Sanford DE AD - Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Doyle, Majella B AU - Doyle MB AD - Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Hammill, Chet W AU - Hammill CW AD - Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Khan, Adeel S AU - Khan AS AD - Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Strasberg, Steven M AU - Strasberg SM AUID- ORCID: 0000-0003-0777-2698 AD - Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA. strasbergs@wustl.edu. LA - eng GR - SPORE Grant 5P50 CA196510/CA/NCI NIH HHS/United States GR - Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842/CA/NCI NIH HHS/United States GR - TL1 TR002344/TR/NCATS NIH HHS/United States GR - P30 CA091842/CA/NCI NIH HHS/United States GR - TL1 TR000449/TR/NCATS NIH HHS/United States GR - P50 CA196510/CA/NCI NIH HHS/United States GR - UL1 TR002345/TR/NCATS NIH HHS/United States GR - UL1 TR000449/NH/NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20191216 PL - Netherlands TA - J Gastrointest Surg JT - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JID - 9706084 SB - IM MH - Humans MH - Length of Stay MH - Outcome Assessment, Health Care MH - *Pancreaticoduodenectomy/adverse effects MH - *Patient Readmission MH - Postoperative Complications/epidemiology/etiology MH - Retrospective Studies MH - Risk Factors PMC - PMC7295670 MID - NIHMS1579347 OTO - NOTNLM OT - Composite length of stay OT - Length of stay OT - MAGS OT - Modified Accordion Grading System OT - Pancreatoduodenectomy OT - Postopertaive complications OT - Postopertaive length of stay OT - Readmission length of stay OT - Readmission rate OT - Whipple procedure COIS- Conflict of Interest The authors declare that they have no conflict(s) of interest. EDAT- 2019/12/18 06:00 MHDA- 2021/04/15 06:00 PMCR- 2021/09/01 CRDT- 2019/12/18 06:00 PHST- 2019/09/21 00:00 [received] PHST- 2019/11/12 00:00 [accepted] PHST- 2019/12/18 06:00 [pubmed] PHST- 2021/04/15 06:00 [medline] PHST- 2019/12/18 06:00 [entrez] PHST- 2021/09/01 00:00 [pmc-release] AID - S1091-255X(23)01726-2 [pii] AID - 10.1007/s11605-019-04475-8 [doi] PST - ppublish SO - J Gastrointest Surg. 2020 Sep;24(9):2062-2069. doi: 10.1007/s11605-019-04475-8. Epub 2019 Dec 16.