Days at Home After Gastrointestinal Cancer Surgery as a Patient-Centered Outcome.

IMPORTANCE

Traditional postoperative outcomes may not fully reflect recovery after gastrointestinal (GI) cancer surgery. Days at home (DAH) is a patient-centered metric that integrates survival, complications, and health care use.

OBJECTIVE

To characterize and identify an optimal postoperative observation window and validate DAH after elective GI cancer surgery.

DESIGN, SETTING, AND

PARTICIPANTS

This was a population-based retrospective cohort study from 2003 to 2021 in Ontario, Canada. Included were adults 18 years and older who underwent elective surgery for GI cancer. Patients were excluded if they were long-term care residents at baseline, underwent emergency surgery, or had another cancer diagnosis within a 2-year lookback. Study data were analyzed from April to November 2025.

EXPOSURES: Covariates explored were age, sex, frailty, comorbidity burden, income quintile, cancer site, histology, metastatic disease, neoadjuvant therapy, procedure type, operative approach, and hospital volume.

MAIN OUTCOMES AND MEASURES: The primary outcome was DAH, defined as days alive and out of health care institutions and assessed at 30, 90, 180, and 365 days. Death during the observation window resulted in a DAH = 0. DAH after surgery at 90 days (DAH-90) was established as an optimal window, based on the proportion of zeros and variability, while considering clinical pathways in GI cancer. Exploratory multivariable quantile regression examined patient, cancer, and treatment factors associated with DAH-90. Quantile plots evaluated these associations across the distribution of DAH-90. Validity was explored through associations with major morbidity (construct validity) and 1-year mortality (criterion validity).

RESULTS

Among 91 270 operations in 89 378 participants (mean [SD] age, 67.3 [12.2] years; 51 343 male [56.2%]), median (IQR) DAH-90 was 82 (77-85) days. DAH-90 varied across cancer site, histology, and procedure. Median (IQR) DAH-90 was lowest for esophageal cancer (76 [63-80] days) and highest for small-bowel cancer (84 [80-86] days). In multivariable quantile regression, preoperative frailty was associated with 2.6 fewer DAH-90 (95% CI, 2.3-2.9 fewer days), whereas laparoscopic approach was associated with 3.0 more DAH-90 (95% CI, 2.9-3.1 more days). DAH-90 was lower among patients with major morbidity (median [IQR], 70 [41-79] days vs 83 [80-85] days; P < .001) and among patients who died within 1 year (median, 62 [0-80] days vs 83 [78-85] days; P < .001).

CONCLUSIONS AND RELEVANCE: Results of this study suggest that DAH-90 was found to be a valid and clinically meaningful outcome after GI cancer surgery. These findings support the use of DAH-90 in patient counseling, quality assessment, and future GI cancer surgery research.