Assessing Rapidity of Recovery After Cancer Surgeries in a Single Overnight Short-Stay Setting

BACKGROUND: In the short-stay surgery setting, where patients remain in hospital for a single overnight at most, it is unclear as to whether postoperative length of stay is a good surrogate for assessing rapidity of recovery. We hypothesized that length of stay would be a function of time of surgery and would be a poorer marker of recovery than time of discharge. METHODS: A cohort of 891 mastectomy and 538 prostatectomy patients had a planned single overnight stay after surgery at an ambulatory surgical hospital during 2016. The relationship between surgical start time and postoperative length of stay or discharge time was assessed. RESULTS: For both mastectomy and prostatectomy patients, 75% of patients were discharged between 10 AM and 12 noon and the median postoperative length of stay was 20 hours. There was a strong association between time of surgery and calculated length of stay. For mastectomies, having a surgery which begins at 6 PM vs 8 AM results in an estimated decrease of 8.8 hours (95% CI, 8.3–9.3) in postoperative length of stay but only 1.2 hours (95% CI, 0.77–1.6) later time of discharge. For prostatectomies, the estimated difference is a decrease of 6.9 hours (95% CI, 6.4–7.4) for postoperative length of stay and 2.5 hours (95% CI, 2.0–3.0) later discharge time. CONCLUSIONS: Postoperative length of stay is a poor outcome measure in a short-stay setting. When assessing rapidity of recovery for single overnight stay patients, we advocate the use of discharge time with adjustment for surgery start time. The effect of surgery start time on both postoperative length of stay and discharge time should be investigated to ascertain which is best to assess rapidity of recovery in other ambulatory care settings where recovery involves a single overnight stay. Accepted for publication November 19, 2018. Funding: This work was supported by National Cancer Institute (P50-CA92629 and P30-CA008748), the Sidney Kimmel Center for Prostate and Urologic Cancers, David H. Koch through the Prostate Cancer Foundation, the Richard Capri Foundation, and Ambulatory Cancer Care Electronic Symptom Self-Reporting for Surgical Patients (R-1602–34355 Patient-Centered Outcomes Research Institute). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to Brett A. Simon, MD, PhD, Department of Surgery and Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1133 York Ave, 3rd Floor, Suite 314, New York, NY 10065. Address e-mail to simonb1@mskcc.org. © 2019 International Anesthesia Research Society

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