Objective: To obtain experience and generate suggestions for reducing average hospital stays, optimizing perioperative management of patients with gastric cancer and improving utilization of medical resources by analyzing the factors influencing super-long hospital stays in patients undergoing radical gastrectomy in the age of enhanced recovery after surgery (ERAS). Methods: This was a case-control study. Inclusion criteria: (1) pathologically diagnosed gastric adenocarcinoma; (2) radical surgery for gastric cancer; and (3) complete clinicopathologic data. Exclusion criteria: (1) history of upper abdominal surgery; (2) presence of distant metastasis of gastric cancer or other ongoing neoplastic diseases; (3) concurrent chemoradiotherapy; and (4) preoperative gastric cancer-related complications such as obstruction or perforation. The study cohort comprised 285 eligible patients with hospital stays of ≥30 days (super-long hospital stay group). Using propensity score matching in a 1:1 ratio, age, sex, medical insurance, pTNM stage, and extent of surgical resection as matching factors, 285 patients with hospital stays of < 30 days during the same period were selected as the control group (non-long hospital stay group). The primary endpoint was relationship between pre-, intra-, and post-operative characteristics and super-long hospital stays. Clavien-Dindo grade was used to classify complications. Results: Univariate analysis showed that number of comorbidities, number of preoperative consultations, preoperative consultation, inter-departmental transference, operation time, open surgery, blood loss, intensive care unit time, presence of surgical or non-surgical complications, Clavien-Dindo grade of postoperative complications, and reoperation were associated with super-long hospital stays (all P<0.05). Inter-departmental transference (OR=4.876, 95% CI: 1.500-16.731, P<0.001), preoperative consultation time ≥ 3 d (OR=1.758, 95%CI: 1.036-2.733, P=0.034), postoperative surgery-related complications (OR = 6.618, 95%CI: 2.141-20.459, P=0.01), and higher grade of complications (Clavien-Dindo Grade I: OR = 7.176, 95%CI: 1.785-28.884, P<0.001; Clavien-Dindo Grade II: OR = 18.984, 95%CI: 6.286-57.312, P<0.001; Clavien-Dindo Grade III-IV: OR=7.546, 95%CI:1.495-37.952, P=0.014) were independent risk factors for super-long hospital stays. Conclusion: Optimizing preoperative management, enhancing perioperative management, and surgical quality control can reduce the risk of prolonging average hospital stay.
目的： 通过分析加速康复背景下胃癌手术患者超长住院时间的影响因素，为优化胃癌围手术期管理，降低平均住院时间，提高医疗资源利用率提供参考依据和指导建议。 方法： 本研究采用回顾性病例对照研究方法。纳入标准：（1）病理诊断为胃腺癌；（2）进行了胃癌根治性手术；（3）临床病理资料完整。排除标准：（1）既往有上腹部手术史；（2）胃癌远处转移或者同期合并其他正在治疗的肿瘤性疾病；（3）同期进行了放化疗等治疗；（4）术前有梗阻、穿孔等胃癌相关并发症。根据上述标准，纳入285例住院时间≥30 d的病例（超长住院时间组）。以年龄、性别、医疗费别、肿瘤pTNM分期和手术切除范围作为匹配因素，通过倾向性评分匹配按照1∶1进行筛选，筛选出同期住院时间<30 d的285例病例作为对照组（非超长住院时间组）。主要观察指标包括两组病例术前、术中、术后等与超长住院时间潜在相关的因素。术后并发症分级采用Clavien-Dindo系统。 结果： 单因素分析显示，合并基础疾病数量多、术前会诊次数多、术前会诊时间≥3 d、转科、手术时间长、开放手术、术中出血量≥200 ml、在重症监护室（ICU）时间长、有手术或非手术相关并发症、术后并发症Clavien-Dindo分级高以及进行二次手术与住院时间超长有关（均P<0.05）。转科（OR=4.876，95%CI：1.500~16.731，P<0.001）、术前会诊时间≥3 d（OR=1.758，95%CI：1.036~2.733，P=0.034）、术后出现手术相关并发症（OR=6.618，95%CI：2.141~20.459，P=0.01）以及并发症等级更高（Clavien-DindoⅠ级：OR=7.176，95%CI：1.785~28.884，P<0.001；Clavien-DindoⅡ级：OR=18.984，95%CI：6.286~57.312，P<0.001；Clavien-Dindo Ⅲ~Ⅳ级：OR=7.546，95%CI：1.495~37.952，P=0.014）均是住院时间超长的独立危险因素。 结论： 通过减少转科、缩短术前会诊时间、提高手术质量和减少术后并发症发生率，可降低平均住院时间延长的风险。.