title: Hospitals with briefer than average lengths of stays for common surgical procedures do not have greater odds of either re-admission or use of short-term care facilities.
abstract: We considered whether senior hospital managers and department chairs need to be concerned that small reductions in average hospital length of stay (LOS) may be associated with greater rates of re-admission, use of home health care, and/or transfers to short-term care facilities. The 2013 United States Nationwide Readmissions Database was used to study surgical Diagnosis Related Groups (DRG) with 1) national median LOS ≥3 days and 2) ≥10 hospitals in the database that each had ≥100 discharges for the DRG. Dependent variables were considered individually: 1) re-admission within 30 days of discharge, 2) discharge disposition to home health care, and/or 3) discharge disposition of transfer to short-term care facility (i.e., inpatient rehabilitation hospital or skilled nursing facility). While controlling for DRG, each one-day decrease in hospital median LOS was associated with an odds of re-admission nationwide of 0.95 (95% confidence interval [CI] 0.92-0.99;P=0.012), odds of disposition upon discharge being home care of 0.95 (95% CI 0.83-1.10;P=0.64), and odds of transfer to short-term care facility of 0.68 (95% CI 0.54-0.85;P=0.0008). Results were insensitive to the addition of patient-specific data. In the USA, patients at hospitals with briefer median LOS across multiple common surgical procedures did not have a greater risk for either hospital re-admission within 30 days of discharge or transfer to an inpatient rehabilitation hospital or a skilled nursing facility. The generalisable implication is that, across many surgical procedures, DRG-based financial incentives to shorten hospital stays seem not to influence post-acute care decisions.
authors.affiliation: Professor and Director of the Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA.
authors.forename: F
authors.initials: F
authors.lastname: Dexter
authors.affiliation: Professor, Department of Anesthesiology, University of Miami, Miami, Florida, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Epstein
authors.affiliation: Assistant Professor, Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: E U
authors.initials: EU
authors.lastname: Dexter
authors.affiliation: Professor and Chair, Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Health System, Miami, Florida, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Lubarsky
authors.affiliation: Instructor, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Sun
mesh_terms: D003953:Diagnosis-Related Groups; D006801:Humans; D007902:Length of Stay; D010359:Patient Readmission; D012047:Rehabilitation Centers; D012866:Skilled Nursing Facilities
keywords: length of stay, re-admissions, home health care, short-term care facilities