The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis.J Gastrointest Surg 2018; 22(9):1538-1548JG
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.
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.
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).
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.