Predictors of Prolonged Hospital Stay After Colorectal Surgery: A Five-Year Retrospective Chart Review in Addis Ababa, Ethiopia
Authors and Affiliations
- Department of Surgery, MCM Comprehensive Specialized Hospital, Addis Ababa, Ethiopia.
- Department of Surgery, Debre Markos University, Ethiopia.
- The Operating Room Global (TORG).
Corresponding author: Dr. Nathan Suga · [email protected]
Abstract
Background: Prolonged hospital stay after colorectal surgery is an important clinical and health-system concern, potentially reflecting complications, delayed recovery and increased resource use. Evidence on predictors in Ethiopian colorectal surgery patients is limited.
Methods: An institution-based retrospective chart review included adult patients undergoing colorectal surgery at MCM Comprehensive Specialized Hospital, Addis Ababa, between 1 January 2021 and 31 December 2025. Data were collected in August 2026 and analysed using SPSS version 27. Prolonged stay was defined as at or above the 75th percentile, and bivariable and multivariable binary logistic regression was performed.
Results: Of 115 patients, 31 (27.0%) experienced prolonged hospitalization of at least 12 days. Absence of preoperative bowel preparation (adjusted odds ratio [aOR] 4.58; 95% CI 1.32–15.87) and minor postoperative complications (aOR 19.04; 95% CI 3.03–119.66) were independently associated with prolonged stay.
Conclusion: Prolonged stay affected more than one-quarter of patients. The authors identify bowel preparation status and postoperative complications as important associated factors and call for standardized perioperative care.
Keywords: Colorectal surgery; Prolonged hospital stays; Length of stay; Postoperative complications; Bowel preparation.
Study at a Glance
Adult colorectal surgery patients treated between 2021 and 2025.
31 patients stayed for 12 days or longer.
20 patients experienced complications.
Study Design
A five-year, single-centre retrospective chart review at MCM Comprehensive Specialized Hospital in Addis Ababa. Of 130 identified records, 15 were excluded because more than 80% of data were missing, leaving 115 patients for analysis. The study used total population sampling and SPSS version 27.
| Baseline / clinical characteristic | Published result |
|---|---|
| Mean age | 54.34 ± 17.01 years (range 18–94) |
| Male patients | 68 (59.1%) |
| Malignant disease | 61 (53.0%) |
| Elective procedures | 74 (64.3%) |
| Open approach | 101 (87.8%) |
| Laparoscopic approach | 10 (8.7%); four additional procedures converted |
| Postoperative complications | 20 (17.4%) |
| Unplanned reoperation | 9 (7.8%) |
| 30-day mortality | 4 (3.5%) |
| Prolonged hospital stay | 31 (27.0%), defined as ≥12 days |
Predictors of Prolonged Hospital Stay
In the primary multivariable logistic regression analysis, the authors reported significant associations for absence of preoperative bowel preparation and minor postoperative complications.
| Predictor (reference group) | Adjusted odds ratio (95% CI) | p-value |
|---|---|---|
| No bowel preparation (vs yes) | 4.58 (1.32–15.87) | 0.017 |
| Minor complications, Clavien–Dindo I–II (vs none) | 19.04 (3.03–119.66) | 0.002 |
| Major complications, Clavien–Dindo III–V (vs none) | 4.05 (0.93–17.59) | 0.062 |
| Abdominal drainage (yes vs no) | 0.50 (0.20–1.27) | 0.145 |
| Age (per year) | 0.98 (0.95–1.01) | 0.235 |
Sensitivity Analysis (n = 111)
After excluding four in-hospital deaths, the association persisted for no bowel preparation (aOR 4.05; 95% CI 1.14–14.43; p = 0.031) and minor complications (aOR 17.10; 95% CI 2.77–105.57; p = 0.002). Major complications were also associated with prolonged stay in this sensitivity analysis (aOR 6.65; 95% CI 1.10–40.16; p = 0.039).
The source PDF contains small discrepancies in some numerical estimates across its abstract, narrative and Tables 3–4. Values above follow the narrative and primary regression table; consult the published PDF for exact source tables.
Discussion, Implications and Limitations
Clinical implications
The authors highlight postoperative complications and bowel preparation status as potential areas for perioperative quality improvement. They recommend standardized pathways, early recognition of complications and strengthening surgical quality monitoring. The discussion acknowledges that bowel preparation recommendations vary by setting and that observational findings do not establish the benefits of routine preparation.
Study limitations
The retrospective, single-centre design limits causal interpretation and generalisability. The sample was relatively small, with 31 prolonged-stay events. Some potentially important variables, including nutritional status, body mass index, recent weight loss, time to resumption of oral intake and performance status, were not systematically captured, leaving possible residual confounding.
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Ethics and Declarations
Ethical approval: Myungsung Medical College (MMC) Research Ethics Committee, Addis Ababa, Ethiopia. Protocol No. PRO-120926.
Conflicts of interest: The authors declare no conflicts of interest relevant to the study.
Funding: No external funding received.
Data availability: Data supporting the findings are available from the corresponding author upon reasonable request.
Artificial intelligence declaration: The authors state that no AI tools were used in the preparation, analysis or writing of the manuscript.
Author contributions: Nathan Suga: conceptualization, methodology, formal analysis, investigation, resources, original draft, visualization and funding acquisition. Jochebed Suga: formal analysis, investigation, resources and data curation. Megbar Dessalegn: conceptualization, methodology, validation, review and editing, supervision and project administration. All authors approved the manuscript.
Acknowledgements: The authors acknowledge the TORG Research Fellowship Programme and mentorship from Prof. Megbar Dessalegn.
Publication Information and Discovery
Received: 18 October 2026
Accepted: 26 October 2026
Published online: 28 October 2026
The Operating Room Global Journal (TORGJ)
ISSN 3105-3262
Volume 2, Issue 4 (December 2026)
Pages 105–116
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