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07.05.2018 | Original Article

The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis

verfasst von: Katiuscha Merath, Fabio Bagante, Qinyu Chen, Eliza W. Beal, Ozgur Akgul, Jay Idrees, Mary Dillhoff, Jordan Cloyd, Carl Schmidt, Timothy M. Pawlik

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 9/2018

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Abstract

Objective

Decreasing hospital length-of-stay (LOS) may be an effective strategy to reduce costs while also improving outcomes through earlier discharge to the non-hospital setting. The objective of the current study was to define the impact of discharge timing on readmission, mortality, and charges following hepatopancreatobiliary (HPB) surgery.

Methods

The Nationwide Readmissions Database (NRD) was used to identify patients undergoing HPB procedures between 2010 and 2014. Length of stay (LOS) was categorized as early discharge (4–5 days), routine discharge (6–9 days), and late discharge (10–14 days). Univariable and multivariable analyses were utilized to identify factors associated with 90-day readmission.

Results

A total of 28,114 patients underwent HPB procedures. Overall median LOS was 7 days (IQR 5–11); 10,438 (37.1%) patients had an early discharge, while 13,665 (48.6%) and 4011 (14.3%) patients had a routine or late discharge. The probability of early discharge increased over time (referent 2010: 2011–4% (OR 1.04, 95% CI 0.96–1.15) vs. 2012–10% (OR 1.10, 95% CI 1.01–1.20) vs. 2013–21% (OR 1.21, 95% CI 1.11–1.32) vs. 2014–32% (OR 1.32, 95% CI 1.21–1.44)) (p < 0.001). Early discharge was associated with insurance status, diagnosis (benign vs. malignant disease), general health, and overall hospital volume (all p < 0.05). Among patients who had an early discharge, 30- and 90-day readmission was 11.5 and 17.4%, respectively. In contrast, 30- and 90-day readmission was 16.9 and 24.7%, respectively, among patients who had a routine discharge group (p < 0.001). Among patients readmitted within 90 days, in-hospital mortality was similar among patients who had early (n = 43, 2.4%) versus routine discharge (n = 65, 1.9%). Median charges were lower among patients who had an early versus routine versus late discharge ($54,476 [IQR 40,053–79,100] vs. $75,192 [IQR 53,296–113,123] vs. $115,061 [IQR 79,162–171,077], respectively) (p < 0.001).

Conclusions

Early discharge after HPB surgery was not associated with increased 30- or 90-day readmission. Overall 90-day in-hospital mortality following a readmission was comparable among patients with an early, routine, and late discharge, while median charges were lower in the early discharge group.

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Titel: The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis
verfasst von: Katiuscha Merath
Fabio Bagante
Qinyu Chen
Eliza W. Beal
Ozgur Akgul
Jay Idrees
Mary Dillhoff
Jordan Cloyd
Carl Schmidt
Timothy M. Pawlik
Publikationsdatum: 07.05.2018
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 9/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3783-0

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The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis