Institutionen för folkhälsovetenskap / Department of Public Health Sciences
Abstract
The present investigation focused on three main questions: what factors
can determine length of stay for primary surgery for breast cancer? can
these factors be attributed to the decreasing trend in mean length of
stay for primary breast-cancer surgery? and can there be any adverse
effect of declining length of stay, such as prolonged sick leave,
following breast-cancer surgery?
For the four studies of the thesis, routinely collected data was used. In
study I the Swedish Hospital Discharge Register was used to describe the
trend in mean length of stay of women surgically treated for breast
cancer and to investigate the effect of the increasing use of
breast-conserving surgery on the decreasing trend in mean length of stay.
In study II the effect of stage of disease on length of stay was
investigated using the Southern Swedish Tumour Register and the Swedish
Hospital Discharge Register. To study the possible adverse effect on
prolonged sick leave of decreasing length of stay, data from the National
Cancer Register, the Sick Leave Register and the National Hospital
Discharge Register were combined (study III). In study IV the effect of
social factors on length of stay was investigated using the Swedish
Social Medicine Database.
In terms of determinant of length of stay, the present results support
the hypothesis that individual factors such as age, severity of cancer
according to tumour size and social factors influence length of stay.
Differences in length of stay according to clinical practice style, such
as different types of surgery, were found. There was a difference of
about 30 per cent in length of stay between breast-conserving surgery and
mastectomy.
The results indicate a small effect of change in type of surgery on the
mean-length-of-stay trend. In the two studies investigating the effect of
changes in surgery on mean length of stay, the calculated effects of the
changes in techniques were 14 and 13 per cent, respectively. Cancer stage
distribution did not affect the trend.
In study III one possible adverse effect of reduced hospital stay was
analyzed, namely the number of sick leave days after discharge. A
statistical correlation between median length of stay for a particular
hospital and number of sick leave days following discharge was
established. Shorter median length of stay for a hospital is related to
longer sick leave periods following care, indicating a possible adverse
effect of shorter length of stay. But long median length of stay for a
hospital was also related to longer sick leave period