Days at home at 90 days validated as a recovery measure after GI cancer surgery

Design

Population-based retrospective cohort

Population

91,270 elective GI cancer operations in Ontario, 2003–2021

Primary outcome

Days alive and at home at 90 days

Effect

Median 82 days (IQR 77–85); frailty −2.6 days (95% CI 2.3 to 2.9)

This population-based cohort used Ontario data on 91,270 elective operations for gastrointestinal cancer between 2003 and 2021. It measured days alive and out of hospital or other institutions, choosing 90 days after surgery as the most informative window.

Median days at home at 90 days was 82 (IQR 77 to 85), lowest after oesophageal surgery (76) and highest after small-bowel surgery (84). Preoperative frailty was associated with 2.6 fewer days (95% CI 2.3 to 2.9), and a laparoscopic approach with 3.0 more days (2.9 to 3.1). Patients with major morbidity had a median of 70 days, and those who died within a year 62.

The measure gives patients a concrete answer to how much of the next three months they are likely to spend at home, which is often what they actually want to know. The associations with frailty and approach are observational and partly reflect who is selected for each.

• Use expected days at home over 90 days when counselling patients before major GI cancer surgery.
• Assess frailty before surgery, since it was linked to fewer days at home.
• Expect fewer days at home after oesophagectomy than after other GI cancer operations.
• Consider days at home as a unit-level quality measure alongside complications and length of stay.

Why it matters

Complication and length-of-stay figures do not tell a patient how much of their recovery will be spent in hospital, and this measure does.

Don't overread it

The extra days with laparoscopy are an association and do not show the approach itself caused them.

The statistics, in plain English

The narrow intervals reflect the very large sample, not the strength of causation. A laparoscopic approach was linked to three more days at home, but laparoscopy is often offered to fitter patients with smaller tumours, so part of that gap is selection.

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