J Gastric Cancer.  2022 Oct;22(4):395-407. 10.5230/jgc.2022.22.e32.

Safe Discharge Criteria After Curative Gastrectomy for Gastric Cancer

• Guner A
• Kim KY
• Park SH
• Cho M
• Kim YM
• Hyung WJ
• Kim HI

• KMID: 2535111
• DOI: http://doi.org/10.5230/jgc.2022.22.e32

Abstract

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.

Keyword

Gastric cancer; Gastrectomy; Postoperative complications; Discharge; Readmission