Safe Discharge Criteria After Curative Gastrectomy for Gastric Cancer

Guner Ali; Kim Ki Yoon; Park Sung Hyun; Cho Minah; Kim Yoo Min; Hyung Woo Jin; Kim Hyoung-Il

doi:10.5230/jgc.2022.22.e32

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저자정보: Guner Ali (Department of Surgery Yonsei University College of Medicine Seoul Korea.Department of General Surge) Kim Ki Yoon (Department of Surgery Yonsei University College of Medicine Seoul Korea.Gastric Cancer Center Yonse) Park Sung Hyun (Department of Surgery Yonsei University College of Medicine Seoul Korea.Gastric Cancer Center Yonse) Cho Minah (Department of Surgery Yonsei University College of Medicine Seoul Korea.Gastric Cancer Center Yonse) Kim Yoo Min (Department of Surgery Yonsei University College of Medicine Seoul Korea.Gastric Cancer Center Yonse) Hyung Woo Jin (Department of Surgery Yonsei University College of Medicine Seoul Korea.Gastric Cancer Center Yonse) Kim Hyoung-Il (Department of Surgery Yonsei University College of Medicine Seoul Korea.Gastric Cancer Center Yonse)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제22권 제4호

발행연도: 2022.10

수록면: 395 - 407 (13page)

DOI: 10.5230/jgc.2022.22.e32

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Purpose This study aimed to investigate the relationship between clinical and laboratory parameters and complication status to predict which patients can be safely discharged from the hospital on the third postoperative day (POD). Materials and Methods Data from a prospectively maintained database of 2,110 consecutive patients with gastric adenocarcinoma who underwent curative surgery were reviewed. The third POD vital signs, laboratory data, and details of the course after surgery were collected. Patients with grade II or higher complications after the third POD were considered unsuitable for early discharge. The performance metrics were calculated for all algorithm parameters. The proposed algorithm was tested using a validation dataset of consecutive patients from the same center. Results Of 1,438 patients in the study cohort, 142 (9.9%) were considered unsuitable for early discharge. C-reactive protein level, body temperature, pulse rate, and neutrophil count had good performance metrics and were determined to be independent prognostic factors. An algorithm consisting of these 4 parameters had a negative predictive value (NPV) of 95.9% (95% confidence interval [CI], 94.2–97.3), sensitivity of 80.3% (95% CI, 72.8–86.5), and specificity of 51.1% (95% CI, 48.3–53.8). Only 28 (1.9%) patients in the study cohort were classified as false negatives. In the validation dataset, the NPV was 93.7%, sensitivity was 66%, and 3.3% (17/512) of patients were classified as false negatives. Conclusions Simple clinical and laboratory parameters obtained on the third POD can be used when making decisions regarding the safe early discharge of patients who underwent gastrectomy.

#Gastric cancer #Gastrectomy #Postoperative complications #Discharge #Readmission

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Guner Ali

소속기관 Department of Surgery Yonsei University College of Medicine Seoul Korea.Department of General Surge