Incidence trends and predictors for cost and average lengths of stay in colorectal cancer surgery

Table 1 Patient characteristics (n = 778)

Variable	n (%)
Gender
Female	320 (41.13)
Male	458 (58.87)
Age (yr)	64.53 ± 12.33
≤ 30	9 (1.16)
31-40	23 (2.96)
41-50	62 (7.97)
51-60	187 (24.04)
61-70	218 (28.02)
71-80	219 (28.15)
≥ 81	60 (7.71)
Source
Health examination	31 (3.98)
Inpatient or emergency room	747 (96.02)
Surgical type
Low anterior resection	197 (25.32)
High anterior resection	82 (10.54)
Abdominoperineal resection	51 (6.56)
Right hemicolectomy	185 (23.78)
Left hemicolectomy	95 (12.2)
Super low anterior resection	138 (17.74)
Endoscopic polypectomy	30 (3.86)
Tumor number	1.05 ± 0.29
Tumor size	5.06 ± 2.14
No. of lymph node metastases	3.56 ± 5.15
Pathologic differentiation
Well	86 (11.05)
Moderate	638 (82.01)
Poor	54 (6.94)
Chemotherapy
No	368 (47.30)
Yes	410 (52.70)
Distant metastasis
No	727 (93.44)
Yes	51 (6.56)
Tumor site
Ascending colon	145 (18.64)
Transverse colon	67 (8.61)
Descending colon	51 (6.56)
Sigmoid colon	278 (35.73)
Rectum	237 (30.46)
Tumor stage
1	144 (18.51)
2	290 (37.28)
3	266 (34.19)
4	78 (10.03)
Treatment cost (dollars)	128543.94 ± 85360.59
Average length of stay (d)	15.40 ± 8.12

Table 2 The incidence rate of colorectal cancer surgery

Year	Patients (n)	Surgeries (n)	Incidence rate (1/105)
2004	245734	30	12.21
2005	621243	99	15.94
2006	727286	158	21.72
2007	782659	136	17.38
2008	825907	199	24.09
2009	877791	157	17.89

Table 3 Logistic regression model for colorectal cancer surgery during periods 1-3¹

Variables		P1 (n = 118)	P2 (n = 273)	P3 (n = 387)	OR (95%CI)
Gender	Female	35.59	44.69	40.31	1.13 (1.01-1.25)
	Male	64.41	55.31	59.69	0.93 (0.83-1.06)
Age (yr)	≤ 30	1.69	1.47	0.78	0.46 (0.33-0.60)
	31-40	2.54	3.30	2.84	1.12 (0.96-1.28)
	41-50	5.93	10.62	6.72	1.13 (0.99-1.27)
	51-60	16.10	20.88	28.68	1.78 (1.58-1.97)
	61-70	35.59	28.94	25.06	0.71 (0.56-0.87)
	71-80	31.36	27.47	27.65	0.88 (0.73-1.03)
	≥ 81	6.78	7.33	8.27	1.22 (1.06-1.37)
Source	Health examination	0.85	4.03	4.91	5.78 (5.48-6.08)
	Inpatient or emergency room	99.15	95.97	95.09	0.96 (0.74-1.18)
Surgical type	Low anterior resection	35.59	25.64	0.62	0.02 (0.00-0.04)
	High anterior resection	3.39	2.2	18.60	5.49 (5.19-5.82)
	Abdominoperineal resection	2.54	4.03	9.56	3.76 (3.54-3.99)
	Right hemicolectomy	20.34	25.64	23.51	1.16 (1.00-1.36)
	Left hemicolectomy	14.41	12.09	11.63	0.81 (0.61-1.05)
	Super low anterior resection	21.19	24.18	12.14	0.57 (0.38-0.76)
	Endoscopic polypectomy	2.54	6.23	2.58	0.31 (0.05-1.77)
Pathologic differentiation	Well	14.41	9.89	10.85	0.75 (0.51-0.92)
	Moderate	77.97	82.78	82.69	1.06 (0.82-1.27)
	Poor	7.63	7.33	6.46	0.85 (0.59-1.05)
Chemotherapy	No	52.54	38.1	52.20	0.99 (0.70-1.37)
	Yes	47.46	61.9	47.80	1.01 (0.80-1.28)
Distant metastasis	No	83.05	93.41	96.64	1.16 (1.05-1.31)
	Yes	16.95	6.59	3.36	0.20 (0.02-0.40)
Tumor site	Ascending colon	18.64	19.05	18.35	0.98 (0.75-1.19)
	Transverse colon	10.17	7.69	8.79	0.86 (0.70-1.06)
	Descending colon	6.78	6.96	6.20	0.91 (0.79-1.14)
	Sigmoid colon	22.88	35.16	40.05	1.75 (1.43-2.23)
	Rectum	41.53	31.14	26.61	0.64 (0.42-0.93)
Tumor stage	1	15.25	16.12	21.19	1.39 (1.12-1.74)
	2	38.98	35.16	38.24	0.98 (0.78-1.19)
	3	38.98	32.60	33.85	0.87 (0.56-1.14)
	4	6.78	6.12	6.72	0.99 (0.80-1.29)

¹Period 3 (P3) vs period 1 (P1) (reference group). P1: 2004-2005; P2: 2006-2007; P3: 2008-2009.

Table 4 Impact factors for predicting the average hospitalization cost and average lengths of stay for colorectal cancer surgery¹

Variables		Average hospitalization cost2			Average lengths of stay3
		Coefficient	Standard coefficient	P value	Coefficient	Standard coefficient	P value
Gender	Female	0.01	0.02	0.344	0.02	0.05	0.140
Age		0.01	0.08	< 0.001	0.01	0.10	0.010
Source	Inpatient or emergency room	-0.17	-0.11	< 0.001	0.10	0.10	0.010
Surgical type	High anterior resection	-0.03	-0.03	0.168	-0.06	-0.11	0.009
	Abdominoperineal resection	0.03	0.03	0.213	0.05	0.07	0.090
	Right hemicolectomy	-0.01	-0.01	0.891	0.01	0.02	0.816
	Left hemicolectomy	-0.01	-0.01	0.625	-0.01	-0.02	0.707
	Super low anterior resection	0.02	0.02	0.478	0.01	0.02	0.687
	Endoscopic polypectomy	-1.16	-0.75	< 0.001	-0.69	-0.14	< 0.001
Tumor number		0.03	0.03	0.110	-0.01	-0.01	0.805
Tumor size		0.01	0.06	0.010	0.01	0.07	0.062
No. of lymph node metastases		0.01	-0.01	0.568	0.01	0.01	0.997
Pathologic differentiation	Moderate	0.04	0.05	0.104	0.04	0.07	0.126
	Poor	0.05	0.04	0.139	0.04	0.05	0.289
Chemotherapy	Yes	-0.01	0.02	0.345	-0.02	-0.05	0.239
Distant metastasis	Yes	0.01	0.01	0.903	0.04	0.06	0.117
Tumor site	Transverse colon	0.01	0.01	0.726	0.09	0.14	0.003
	Descending colon	0.02	0.02	0.557	0.04	0.06	0.287
	Sigmoid colon	0.01	0.02	0.730	0.06	0.15	0.149
	Rectum	0.03	0.04	0.514	0.04	0.11	0.314
Tumor stage	2	0.04	0.06	0.076	0.03	0.07	0.198
	3	0.05	0.08	0.019	0.03	0.08	0.177
	4	0.17	0.17	< 0.001	0.09	0.15	0.002

¹Reference groups: gender (male), source (health examination), surgical type (low anterior resection), pathologic differentiation (well), chemotherapy (no), distant metastasis (no), tumor site (ascending colon), tumor stage (1);

²R² = 0.68 and adjusted R²=0.67;

³R² = 0.42 and adjusted R² = 0.39.