TY - JOUR
T1 - Is Early Too Early? Effect of Shorter Stays After Bypass Surgery
AU - Cowper, Patricia A.
AU - DeLong, Elizabeth R.
AU - Hannan, Edward L.
AU - Muhlbaier, Lawrence H.
AU - Lytle, Barbara L.
AU - Jones, Robert H.
AU - Holman, William L.
AU - Pokorny, Janel J.
AU - Stafford, Judith A.
AU - Mark, Daniel B.
AU - Peterson, Eric D.
N1 - Funding Information:
This research was funded by the Agency for Healthcare Research and Quality (Grant R01 HS10279). No conflict of interest exists for any authors. We thank ResDAC for assisting with acquisition of Medicare claims, the New York State Department of Health for providing clinical and administrative data, and the New York City Department of Health for providing vital statistics.
PY - 2007/1
Y1 - 2007/1
N2 - Background: Postoperative stays after coronary artery bypass graft surgery (CABG) decreased substantially in the 1990s. Although shorter stays offer clinical benefits, premature discharge could increase adverse events and offset initial savings. This study examined the effect of early discharge after CABG on readmission/death and cost within 60 days of discharge home. Variability in hospitals' tendencies for early discharge and adverse outcomes was also explored. Methods: Analyses were based on clinical and claims data for 55,889 New York CABG patients discharged home 1995 to 1998. Early discharge was defined as a postoperative stay below the 15th percentile for patients with similar risk. The likelihood of early discharge and its effect on readmission/death were examined using hierarchical logistic regression, accounting for patient risk and within-hospital correlation. The correlation between early discharge and adverse outcomes at the hospital level was assessed. The effect of early discharge on subsequent inpatient, outpatient, skilled nursing, and home health costs was examined in the Medicare subset. Results: Overall, 17% of patients were discharged early, with increasing prevalence over time. The tendency to discharge early varied widely among hospitals (2% to 42% of patients). We found no association between hospitals' tendencies for early discharge and adverse outcomes. Lower postdischarge costs among patients discharged early (mean = $3,491 versus $5,246 for typical stays) resulted in average cumulative savings of $6,309. Conclusions: Patients selected for earlier discharge after CABG did not have increased adverse event rates or higher costs. Variation among hospitals in early discharge suggests that more efficient patient management could be achieved at some hospitals.
AB - Background: Postoperative stays after coronary artery bypass graft surgery (CABG) decreased substantially in the 1990s. Although shorter stays offer clinical benefits, premature discharge could increase adverse events and offset initial savings. This study examined the effect of early discharge after CABG on readmission/death and cost within 60 days of discharge home. Variability in hospitals' tendencies for early discharge and adverse outcomes was also explored. Methods: Analyses were based on clinical and claims data for 55,889 New York CABG patients discharged home 1995 to 1998. Early discharge was defined as a postoperative stay below the 15th percentile for patients with similar risk. The likelihood of early discharge and its effect on readmission/death were examined using hierarchical logistic regression, accounting for patient risk and within-hospital correlation. The correlation between early discharge and adverse outcomes at the hospital level was assessed. The effect of early discharge on subsequent inpatient, outpatient, skilled nursing, and home health costs was examined in the Medicare subset. Results: Overall, 17% of patients were discharged early, with increasing prevalence over time. The tendency to discharge early varied widely among hospitals (2% to 42% of patients). We found no association between hospitals' tendencies for early discharge and adverse outcomes. Lower postdischarge costs among patients discharged early (mean = $3,491 versus $5,246 for typical stays) resulted in average cumulative savings of $6,309. Conclusions: Patients selected for earlier discharge after CABG did not have increased adverse event rates or higher costs. Variation among hospitals in early discharge suggests that more efficient patient management could be achieved at some hospitals.
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U2 - 10.1016/j.athoracsur.2006.08.001
DO - 10.1016/j.athoracsur.2006.08.001
M3 - Article
C2 - 17184638
AN - SCOPUS:33845509497
SN - 0003-4975
VL - 83
SP - 100
EP - 107
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -