Decreased length of stay for patients with colorectal cancer: implications of DRG use.
Hospital length of stay (LOS) has declined significantly at Mt. Sinai Hospital with the advent of diagnosis-related groups (DRGs). Patients with colorectal cancer who were operated on before and after the implementation of the DRG were compared to determine whether the shorter LOS reflected changes in the patient population or changes in the way patients were being treated. Both preoperative and postoperative LOS declined significantly for DRG patients. The decreased LOS for DRG patients could not be attributed to a decreased severity of disease because DRG patients presented with significantly more advanced tumors. The DRG patients had significantly less operative blood loss; shorter, less extensive procedures; fewer transfusion; shorter specimen lengths; shorter margins of resection; and fewer postoperative complications than the pre-DRG patients. Other measures of disease severity (i.e., admission hematocrit, tumor differentiation, and tumor size) and patient mix (i.e., age and sex) did not change. These results suggest that with the use of DRGs, surgeons may have modified certain aspects of treatment for colorectal cancer in an attempt to shorten LOS.
Schwartz
M H
MH
Cornell University Medical College, NY, USA.
Tartter
P I
PI
D000368:Aged; D016063:Blood Loss, Surgical; D015179:Colorectal Neoplasms / Q000601:surgery*; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009518:New York; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000706:statistics & numerical data; D011445:Prospective Payment System; D012720:Severity of Illness Index