Determinants of days alive and out of hospital (DAOH-90) following gastrointestinal cancer surgery:  A retrospective cohort study

Fatih Gürsoy; Mehmet Emin Gönüllü; Erman Yekenkurul; Mehmet Fuat Çetin; İsmet Özaydın

doi:10.26900/hsq.3180

Authors

Fatih Gürsoy Afyonkarahisar Health Sciences University / Türkiye 0000-0001-8299-494X
Mehmet Emin Gönüllü Bilecik Seyh Edebali University / Türkiye 0000-0001-9126-2396
Erman Yekenkurul Düzce University / Türkiye 0000-0002-6725-4289
Mehmet Fuat Çetin Düzce University / Türkiye 0000-0002-9418-7288
İsmet Özaydın Düzce University / Türkiye 0000-0001-9661-328X

10.26900/hsq.3180

Abstract

Gastrointestinal malignancies are associated with substantial postoperative morbidity and mortality, and traditional outcome measures often fail to fully reflect the complexity of postoperative recovery. Days Alive and Out of Hospital within 90 days (DAOH-90) has emerged as a comprehensive and patient-centered metric that integrates survival, hospitalization, and readmissions into a single outcome. However, data regarding its determinants in heterogeneous gastrointestinal cancer populations remain limited. This retrospective, single-center cohort study included 208 patients who underwent elective curative-intent surgery for gastrointestinal malignancies between January 2015 and July 2025. Demographic, clinical, surgical, and postoperative data were obtained from institutional records. The primary outcome was DAOH-90. The median DAOH-90 was 72 days (IQR: 58-82). Patients with lower DAOH-90 were significantly older (67.8 ± 10.9 vs. 60.6 ± 11.8 years, p<0.001), had higher ASA scores (63.5% vs. 20.2% for ASA ≥III, p<0.001), and greater Charlson Comorbidity Index values (median 5 vs. 3, p<0.001). Operative time and intraoperative blood loss were also significantly higher in this group (p<0.001 for both). Postoperative complications (82.7% vs. 30.8%, p<0.001), readmission (38.5% vs. 11.5%, p<0.001), and 90-day mortality (21.2% vs. 0%, p<0.001) were more frequent among patients with lower DAOH-90. DAOH-90 demonstrated a strong negative correlation with length of hospital stay (r = -0.622, p<0.001). In multivariable analysis, ASA score (β = -0.241, p<0.001), Charlson Comorbidity Index (β = -0.198, p=0.001), operative time (β = -0.173, p=0.003), postoperative complications (β = -0.352, p<0.001), and readmission (β = -0.226, p<0.001) were independently associated with reduced DAOH-90. These findings suggest that DAOH-90 may serve as a comprehensive and clinically meaningful outcome measure reflecting the combined effects of patient-related and perioperative factors; however, the results should be interpreted with caution, and further prospective, multicenter studies are warranted to validate these observations.

Keywords:

DAOH-90 gastrointestinal cancer surgery postoperative outcomes

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