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

• Published in: Anaesthesia and intensive care 2017-03, Vol.45 (2), p.210-219
• Main Authors: Dexter, F., Epstein, R. H., Dexter, E. U., Lubarsky, D. A., Sun, E. C.
• Format: Article
• Language: English
• Subjects: Administration; Diagnosis-Related Groups; Health facilities; Home care services; Hospital utilization; Hospitals; Humans; Length of Stay; Patient Readmission; Rehabilitation Centers; Skilled Nursing Facilities; Surgical intensive care
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X1704500211

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.