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The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery.
J Surg Res. 2019 07; 239:292-299.JS

Abstract

BACKGROUND

Index length of stay (LOS) and readmissions are viewed as important quality measures. However, these metrics represent competing demands as an inordinate reduction in LOS may lead to unplanned readmissions. We sought to assess the optimal LOS associated with the lowest 90-d readmission rate following discharge after common surgical procedures.

MATERIALS AND METHODS

This was a retrospective study relying on Tricare claims. We identified all eligible adult patients (18-64 y) receiving a series of common surgical procedures between 2006 and 2014. We used a generalized additive model with spline regression to determine the optimal LOS associated with the lowest 90-d risk of readmission.

RESULTS

Ninety-day readmission rates varied from 6.03% to 34.69%. Most procedures exhibited a logit linear relationship, with the lowest risk of readmission evident on postoperative day-1 and increasing thereafter. Among the more invasive procedures (e.g., esophagectomy and radical cystectomy), a U-shaped relationship was realized, indicating that expedited discharge would increase the potential for readmission as would any extended hospital LOS. For these procedures, the ideal index LOS appeared to be 6-7 d for radical cystectomy and 12-13 d for esophagectomy.

CONCLUSIONS

Our results support the practice of discharging patients as soon as clinically feasible after hip and knee arthroplasty, lumbar spine surgery, hernia repair, appendectomy, nephrectomy, and colectomy. Among esophagectomy or radical cystectomy, there is a well-defined optimal index admission period and discharge outside this window appears to be detrimental. Our results suggest that invasive procedures appear to possess a unique "signature" when it comes to optimal LOS.

Authors+Show Affiliations

Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Center for Surgery and Public Health, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: ajschoen@neomed.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

30901721

Citation

Andriotti, Tomas, et al. "The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery." The Journal of Surgical Research, vol. 239, 2019, pp. 292-299.
Andriotti T, Goralnick E, Jarman M, et al. The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery. J Surg Res. 2019;239:292-299.
Andriotti, T., Goralnick, E., Jarman, M., Chaudhary, M. A., Nguyen, L. L., Learn, P. A., Haider, A. H., & Schoenfeld, A. J. (2019). The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery. The Journal of Surgical Research, 239, 292-299. https://doi.org/10.1016/j.jss.2019.02.032
Andriotti T, et al. The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery. J Surg Res. 2019;239:292-299. PubMed PMID: 30901721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery. AU - Andriotti,Tomas, AU - Goralnick,Eric, AU - Jarman,Molly, AU - Chaudhary,Muhammad A, AU - Nguyen,Louis L, AU - Learn,Peter A, AU - Haider,Adil H, AU - Schoenfeld,Andrew J, Y1 - 2019/03/19/ PY - 2018/11/27/received PY - 2019/02/12/revised PY - 2019/02/19/accepted PY - 2019/3/23/pubmed PY - 2020/1/25/medline PY - 2019/3/23/entrez KW - Hospital length of stay KW - Readmission KW - Surgery SP - 292 EP - 299 JF - The Journal of surgical research JO - J. Surg. Res. VL - 239 N2 - BACKGROUND: Index length of stay (LOS) and readmissions are viewed as important quality measures. However, these metrics represent competing demands as an inordinate reduction in LOS may lead to unplanned readmissions. We sought to assess the optimal LOS associated with the lowest 90-d readmission rate following discharge after common surgical procedures. MATERIALS AND METHODS: This was a retrospective study relying on Tricare claims. We identified all eligible adult patients (18-64 y) receiving a series of common surgical procedures between 2006 and 2014. We used a generalized additive model with spline regression to determine the optimal LOS associated with the lowest 90-d risk of readmission. RESULTS: Ninety-day readmission rates varied from 6.03% to 34.69%. Most procedures exhibited a logit linear relationship, with the lowest risk of readmission evident on postoperative day-1 and increasing thereafter. Among the more invasive procedures (e.g., esophagectomy and radical cystectomy), a U-shaped relationship was realized, indicating that expedited discharge would increase the potential for readmission as would any extended hospital LOS. For these procedures, the ideal index LOS appeared to be 6-7 d for radical cystectomy and 12-13 d for esophagectomy. CONCLUSIONS: Our results support the practice of discharging patients as soon as clinically feasible after hip and knee arthroplasty, lumbar spine surgery, hernia repair, appendectomy, nephrectomy, and colectomy. Among esophagectomy or radical cystectomy, there is a well-defined optimal index admission period and discharge outside this window appears to be detrimental. Our results suggest that invasive procedures appear to possess a unique "signature" when it comes to optimal LOS. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/30901721/The_Optimal_Length_of_Stay_Associated_With_the_Lowest_Readmission_Risk_Following_Surgery L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(19)30098-8 DB - PRIME DP - Unbound Medicine ER -