Received: 6 February 2017
Accepted: 19 September 2017
Factors affecting hospital length of stay following pelvic
Ying Guo MD
Eugene Chang MD
Mehtap Bozkurt MD
Minjeong Park PhD
Diane Liu MS
Jack B. Fu MD
Department of Palliative, Rehabilitation, and
Integrative Medicine, The University of Texas
MD Anderson Cancer Center, Houston, Texas
Department of Medicine, Division of
Physical Medicine and Rehabilitation, Toronto
Rehabilitation Institute, Toronto, Canada
Department of Physical Medicine and
Rehabilitation, Dicle University Faculty of
Medicine, Diyarbakir, Turkey
Department of Biostatistics, The University
of Texas MD Anderson Cancer Center,
Ying Guo, MD, Department of Palliative,
Rehabilitation, and Integrative Medicine, The
University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd Unit 1414,
Houston, TX 77030.
The National Institutes of Health,
Grant number: P30CA016672
Background and Objectives: Total pelvic exenteration are performed in patients with
locally advanced or recurrent pelvic malignances. Many patients have prolong hospital
length of stay (LOS), but risk factors are not clearly identified.
Methods: From 2002 through 2012, 100 consecutive patients undergoing pelvic
exenteration were retrospectively reviewed. A general linear model was used to
examine risk factors for prolonged hospital LOS.
Results: Among the 100 patients, 51 had gastrointestinal cancer, 14 had genitourinary
cancer, 31 had gynecologic cancer, and 4 had sarcoma. Perioperative complications
included infection (n = 44), anastomotic leak/fistula (n = 6), wound or flap dehiscence
(n = 11), and ileus or bowel obstruction (n = 30). The median (Interquartile range (IQR))
hospital LOS was 15 days (10-21.5 days). On multivariate regression analysis, hospital
LOS was significantly prolonged by underweight status, genitourinary cancer or
sarcoma diagnosis, ≥2 infections, anastomotic leak/fistula, requiring rehabilitation
consult and admission, and ≥2 consultations (P = 0.05).
Conclusion: In patients undergoing pelvic exenteration, prolonged hospital LOS is
associated with underweight status, genitourinary cancer or sarcoma diagnosis, more
than one infection, anastomotic leak/fistula, requiring rehabilitation consult and
admission, and more than one consultation. Further study is needed to assess whether
minimizing these risk factors can improve hospital LOS in these patients.
cancer, hospital length of stay, pelvic exenteration
Pelvic exenteration surgery, used to treat advanced gastrointesti-
and urologic malignancy,
is an extensive
surgery that involves en bloc removal of the pelvic viscera. A total
pelvic exenteration in a male includes removal of the rectum,
bladder, and prostate/seminal vesicles if present. In a female patient,
a total pelvic exenteration includes removal of the bladder, vagina
(part or complete), uterus if present, and rectum.
exenteration has significant advantages for longer disease-free and
overall survival, its associated perioperative complications, including
hemorrhage and infections, can negatively impact a patient's
Wound infection is one of the most common postoperative
complications. In patients who underwent pelvic exenteration,
estimated infection rates were up to 30-43%,
and the rate of
pelvic abscess was reported to be 6-20%.
can affect quality of life, impact recovery, prolong hospital length of
stay (LOS), and increase the readmission rate. Prolonged hospitaliza-
tion and readmissions also can increase overall healthcare costs.
However, few studies have assessed the risk factors for prolonged LOS
in patients who undergo pelvic exenteration. We know of only such
J Surg Oncol. 2018;117:529–534. wileyonlinelibrary.com/journal/jso © 2017 Wiley Periodicals, Inc.