The influence of hospital environment on postoperative length of stay following major colorectal surgery

Introduction Elective colorectal resection is associated with a postoperative stay (LOS) of 7-10 days. Counties Manukau District Health Board (DHB) has two sites for elective colorectal surgery: Manukau Surgery Centre (MSC)-a stand-alone elective surgical site; and Middlemore Hospital (MMH)-a general hospital. MSC opened in 2001 and it was noted that patients recovered more quickly there than patients operated on at MMH. It was thus our aim to identify if LOS following major elective colorectal surgery is influenced by hospital environment. Methods 294 consecutive patients undergoing elective colorectal resection between January 2002 and October 2005 at the two facilities were analysed. Confounding factors (age, gender, race, duration of surgery, ASA grade, colonic vs rectal surgery, stoma/no stoma) were identified and corrected for using a multivariate Poisson log-linear regression model. Results Patients who underwent surgery (colonic=227, rectal=67) at MMH (n=210, median length of stay 11 days) had a LOS 1.52 times longer (95%CI 1.28-1.81) than those who had their surgery at MSC (n=84, median length of stay 7 days). This figure was corrected for all other variables (p<0.0001). Conclusion Because MSC and MMH are both part of the same DHB, share the same surgeons, and service an identical population, it can be concluded that environmental differences are likely to be influential in the recovery process. However, further research is required to elucidate the significance of individual factors.