Length of hospital stay after uncomplicated gastrectomy in the Netherlands: a nationwide cohort study

Background: Longer length of hospital stay (LOS) has an impact on patient lives and hospital costs. As 60%–70% of gastrectomies are uncomplicated, identifying factors influencing LOS after uncomplicated gastrectomy could help reduce LOS. This study examined hospital variation in LOS and its association with readmission after uncomplicated gastrectomy. Methods: Patients undergoing gastrectomy for gastric cancer in the Netherlands were included from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Patients with any complications (Gastric Complications Consensus Group definitions) were excluded. LOS was dichotomized around the national median into early and late discharge. Hospital variation was investigated using (case-mix corrected) funnel plots. The association of LOS with patient, tumor, and treatment characteristics and 30-day readmission were investigated using multilevel multivariable logistic regression analyses. Results: Between 2019 and 2023, a total of 1,761 gastrectomies were performed, of which 1,235 had an uncomplicated postoperative course. The national median LOS was 5 days (IQR:4–6), ranging from 3 to 7 days among the 14 Dutch gastrectomy centers. After case-mix correction, one hospital had significantly higher and three had lower early discharge rates. For total and subtotal gastrectomy separately, only one hospital had significantly lower early discharge rates. Open surgery (OR:8.43; 95%CI:4.75–15.0) and age > 75 years (OR:1.72; 95%CI:1.17–2.51) were associated with prolonged LOS (> 5 days), while subtotal gastrectomy (OR:0.24; 95%CI:0.16–0.36) was associated with early discharge (≤ 5 days). The 30-day readmission rate was 6.0%, with no association with early discharge. When including complicated patients, postoperative complications were the most dominant factor of late discharge, both minor (OR:7.7; 95%CI:4.9–12.1) and severe complications (OR:9.6; 95%CI:6.7–13.8). Conclusions: Significant hospital variation in LOS after uncomplicated gastrectomy was found in the Netherlands. The primary factors affecting LOS were surgical approach (open vs. minimally invasive) and type of gastrectomy performed (total vs. subtotal). Early discharge did not increase readmission risk.