Early discharge does not increase readmission or mortality after high-risk vascular surgery

Abstract

Purpose Clinical pathways aimed at reducing hospital length of stay following vascular surgery have been broadly implemented to reduce costs. However, early hospital discharge may adversely affect the risk of readmission or mortality. To address this question, we examined the relationship between early discharge and 30-day outcomes among patients undergoing a high-risk vascular surgery procedure, thoracic aortic aneurysm (TAA) repair. Methods Using Medicare claims from 2000 to 2007, we identified all patients who were discharged home following elective thoracic endovascular aneurysm repair (TEVAR) and open repair for nonruptured TAAs. For each procedure, we examined the correlation between early discharge (<3 days for TEVAR, <7 days for open TAA repair) and 30-day readmission, 30-day mortality, and hospital costs. Predictors of readmission were evaluated using logistic regression models controlling for patient comorbidities, perioperative complications, and discharge location. Results Our sample included 9764 patients, of which 7850 (80%) underwent open TAA repair, and 1914 (20%) underwent TEVAR. Patients discharged to home early were more likely to be female (66% early vs 56% late), Caucasian (94% early vs 91% late), younger (73 years early vs 74 years late), and have fewer comorbidities (mean Charlson score: 0.7 early vs 1.0 late) than patients discharged home late (all P < .01). As compared with patients who were discharged late, patients discharged home early following uncomplicated open TAA repair and TEVAR had significantly lower 30-day readmission rates ([open: 17% vs 24%; P < .001] [TEVAR: 12% vs 23%; P < .001]) and hospital costs ([open: $73,061 vs $136,480; P < .001] [TEVAR: $58,667 vs $128,478; P < .001]), without an observed increase in 30-day postdischarge mortality. In multivariable analysis, early hospital discharge was associated with a significantly lower likelihood of readmission following both open TAA repair (odds ratio, 0.70; 95% confidence interval, 0.57–0.85; P < .001) and TEVAR (odds ratio, 0.57; 95% confidence interval, 0.38–0.85; P < .01) procedures. Conclusions Discharging patients home early following uncomplicated TEVAR or open TAA repair is associated with reduced hospital costs without adversely impacting 30-day readmission or mortality rates. These data support the safety and cost-effectiveness of programs aimed at early hospital discharge in selected vascular surgery patients.

General and Vascular Surgery Readmissions: A Systematic Review

“…(10–13) The final yield was a total of 39 articles included in this review. (10–48) The resulting articles were then categorized by surgical specialty: vascular surgery (n=10), (10,11,14–21) general surgery (n=8), (12,13,22–27) bariatric surgery (n=5) (28–32) and colorectal surgery (n=16). (33– 48)…”

Early Primary Care Provider Follow-up and Readmission After High-Risk Surgery

“…5 Accordingly, these procedures have been selected as a potential target for nonreimbursement for readmissions. Within this high-risk population, we examined whether early PCP follow-up visits in addition to surgical follow-up was associated with lower rates of readmission.…”

Next day discharge after elective intracranial aneurysm coiling: is it safe?

“…However, there is some literature investigating early discharge in patients undergoing minimally invasive vascular interventions. Brooke et al 9 investigated early discharge in patients treated with TEVAR versus open abdominal aortic aneurysm surgery and found no significant difference in hospital readmissions or mortality (30-day adverse events) for early discharge patients undergoing uncomplicated TEVAR or open surgery. Our study provides preliminary evidence for a prospective study evaluating early versus standard discharge in elective aneurysm coiling.…”

“…The primary outcome measure was complication after discharge (30-day adverse events),9 defined as procedure-related visits to the ED including new neurologic events, readmission, or death within 30 days after discharge from the hospital. Patients who had procedure-related complications leading to a prolonged admission of >30 days were assigned to the 30-day adverse event group.…”

“…There is a paucity of literature evaluating early discharge for any endovascular procedure. One study investigated early and standard discharge for patients with thoracic endovascular aneurysm repair (TEVAR) compared with open surgery 9. However, there is a lack of data evaluating the predictors of return visits to the emergency department (ED) or hospital after elective aneurysm coiling.…”