Reducing Length of Hospital Stay Does Not Increase Readmission Rates in Early-Stage Gastric, Colon, and Lung Cancer Surgical Cases in Japanese Acute Care Hospitals

• Published in: PloS one 2016-11, Vol.11 (11), p.e0166269-e0166269
• Main Authors: Kunisawa, Susumu, Fushimi, Kiyohide, Imanaka, Yuichi
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Colon; Colon - surgery; Colon cancer; Colonic Neoplasms - epidemiology; Colonic Neoplasms - surgery; Colorectal cancer; Councils; Discharge; Emergency Medical Services; Gastric cancer; Health care; Health care policy; Hospitals; Humans; Japan - epidemiology; Length of Stay; Lung - surgery; Lung cancer; Lung diseases; Lung Neoplasms - epidemiology; Lung Neoplasms - surgery; Medicine and Health Sciences; Mortality; Patient Readmission; Patients; Quality of Health Care; Stomach - surgery; Stomach Neoplasms - epidemiology; Stomach Neoplasms - surgery; Studies; Surgery
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0166269

The Japanese government has worked to reduce the length of hospital stay by introducing a per-diem hospital payment system that financially incentivizes the timely discharge of patients. However, there are concerns that excessively reducing length of stay may reduce healthcare quality, such as increasing readmission rates. The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals. We used an administrative claims database under the Diagnosis Procedure Combination Per-Diem Payment System for Japanese hospitals. Using this database, we selected hospitals that provided data continuously from July 2010 to March 2014 to enable analyses of temporal changes in length of stay and readmission rates. We selected stage I (T1N0M0) gastric, colon, and lung cancer surgical patients who had been discharged alive from the index hospitalization. The outcome measures were length of stay during the index hospitalization and unplanned emergency readmissions within 30 days after discharge. From among 804 hospitals, we analyzed 42,585, 15,467, and 40,156 surgical patients for gastric, colon, and lung cancer, respectively. Length of stay was reduced by approximately 0.5 days per year. In contrast, readmission rates were generally stable at approximately 2% or had decreased slightly over the 4-year period. In early-stage gastric, colon, and lung cancer surgical patients in Japan, reductions in length of stay did not result in increased readmission rates.