Abstract
BACKGROUND: Postoperative length of hospital stay (PLOS) is an important indicator of surgical quality. Prolonged PLOS (PPLOS) escalates treatment costs and delays the transition from surgery to adjuvant chemotherapy. Additionally, PPLOS can negatively affect long-term prognosis. The predictive factors for PPLOS, particularly following highly advanced hepatobiliary-pancreatic surgery (HBPS), remains insufficiently studied. In this study, we defined PPLOS as a PLOS exceeding the 75th percentile of the cohort and aimed to identify perioperative predictors of PPLOS following highly advanced HBPS. METHODS: This single-center retrospective study included 737 patients who underwent highly advanced HBPS at Gifu University Hospital, Japan, between January 2010 and December 2023. Perioperative predictive factors associated with PPLOS were analyzed in patients with severe postoperative complications within 30 days of surgery (n = 181; Clavien-Dindo classification grades III or IV) using univariate and multivariate analyses. RESULTS: Among the included patients, 45 experienced PPLOS, with the 75th percentile of PLOS being 53 days. Univariate analysis identified intra-abdominal abscess, pancreatic fistula, postoperative bleeding, hepatic failure, unplanned intubation, C-reactive protein to albumin ratio (CAR) on postoperative day (POD)3, and neutrophil to lymphocyte ratio (NLR) on POD3 as significantly correlated with PPLOS. Multivariate analysis revealed that CAR on POD3 > 5.0 was the only independent predictor for PPLOS (odds ratio, 3.22; 95% confidence interval, 1.11-10.17; p = 0.03). CONCLUSIONS: PLOS was significantly prolonged in patients undergoing highly advanced HBPS who developed severe postoperative complications, regardless of surgery type (hepatobiliary or pancreatic). Among these patients, an elevated CAR on POD3 emerged as an early independent predictor of PPLOS. These findings highlight the significance of early postoperative monitoring and intervention based on CAR to reduce the risk of PPLOS following highly advanced HBPS and thus, minimize severity of postoperative complications.