Outcomes of Expedited Discharge After Isolated Coronary Artery Bypass Grafting

Williamson, Catherine; Ebrahimian, Shayan; Benharash, Peyman; Tran, Zachary; Kim, Samuel T.; Benharash, Peyman

doi:10.1053/j.jvca.2022.06.012

Cited by 5 publications

(8 citation statements)

References 28 publications

(32 reference statements)

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“…With increasing emphasis on value‐based healthcare, examination of center‐level variation is particularly important, given that patient factors are often not modifiable. In the present study, we found ∼29% of the variation in post‐transplant LOS to be attributable to the operating institution, which corroborates prior reports from our group assessing hospital‐level utilization of early discharge pathways in anatomic lung resection and coronary artery bypass grafting 26,27 . Moreover, we observed that centers with high rates of early discharge had significantly greater transplantation volume and superior patient survival.…”

Section: Discussionsupporting

confidence: 90%

“…In the present study, we found ∼29% of the variation in post-transplant LOS to be attributable to the operating institution, which corroborates prior reports from our group assessing hospital-level utilization of early discharge pathways in anatomic lung resection and coronary artery bypass grafting. 26,27 Moreover, we observed that centers with high rates of early discharge had significantly greater transplantation volume and superior patient survival. These findings are in congruence with a large body of literature that reports increasing center volume to be associated with improved outcomes across a multitude of complex surgical procedures.…”

Section: Discussionmentioning

confidence: 79%

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Postoperative length of stay following kidney transplantation in patients without delayed graft function—An analysis of center‐level variation and patient outcomes

Bakhtiyar

Benharash

Verma

et al. 2023

Clinical Transplantation

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Background: Early discharge after surgical procedures has been proposed as a novel strategy to reduce healthcare expenditures. However, national analyses of the association between discharge timing and post-transplant outcomes following kidney transplantation are lacking. Methods: This was a retrospective cohort study of all adult kidney transplant recipients without delayed graft function from 2014 to 2019 in the Organ Procurement and Transplantation Network and Nationwide Readmissions Databases. Recipients were divided into Early (LOS ≤ 4 days), Routine (LOS 5-7), and Delayed (LOS > 7) cohorts. Results: Of 61 798 kidney transplant recipients, 26 821 (43%) were discharged Early and 23 279 (38%) Routine. Compared to Routine, patients discharged Early were younger (52 [41-61] vs. 54 [43-62] years, p < .001), less commonly Black (33% vs. 34%, p < .001), and more frequently had private insurance (41% vs. 35%, p < .001). After adjustment, Early discharge was not associated with inferior 1-year patient survival (Hazard Ratio [HR] .74, 95% Confidence Interval [CI] 0.66-0.84) or increased likelihood of nonelective readmission at 90-days (HR .93, CI .89-.97), relative to Routine discharge. Discharging all Routine patients as Early would result in an estimated cost saving of ∼$40 million per year. Multi-level modeling of post-transplantationLOS revealed that 28.8% of the variation in LOS was attributable to interhospital differences rather than patient factors.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 79%

Postoperative length of stay following kidney transplantation in patients without delayed graft function—An analysis of center‐level variation and patient outcomes

Bakhtiyar

Benharash

Verma

et al. 2023

Clinical Transplantation

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“…associated with a $3,400 decrement in episodic expenditure, which is most attributable to shortened length of stay. In agreement with our findings, prior studies of patients undergoing coronary artery bypass grafting and anatomic lung resection have noted cost-savings between $3,000 and $5,000 among those discharged early [7,8]. Moon et al analyzed the 2011-2017 NRD and found expedited discharge following colorectal resection to be associated with reduced costs at the index admission but greater costs upon rehospitalization [4].…”

Section: Plos Onesupporting

confidence: 91%

“…Among several cost containment strategies, early discharge pathways have garnered significant interest across surgical specialties [5][6][7][8]. Early discharge following colectomy has been facilitated, in part, by Enhanced Recovery After Surgery (ERAS) protocols, which aim to reduce surgical stress, complications and length of stay [9].…”

Section: Introductionmentioning

confidence: 99%

“…Early discharge following colectomy has been facilitated, in part, by Enhanced Recovery After Surgery (ERAS) protocols, which aim to reduce surgical stress, complications and length of stay [9]. While the relative safety of early discharge has been established in cardiothoracic and foregut surgery, concerns regarding increased readmissions remain for patients undergoing colectomy [5,7,8,10]. Such apprehensions may stem from early reports of high readmissions among those discharged before postoperative day 4, as well as pragmatic limitations to patient monitoring following discharge [10].…”

Section: Introductionmentioning

confidence: 99%

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Early discharge following colectomy for colon cancer: A national perspective

Verma,

Bakhtiyar,

Ali

et al. 2024

PLoS ONE

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Background Although early discharge after colectomy has garnered significant interest, contemporary, large-scale analyses are lacking. Objective The present study utilized a national cohort of patients undergoing colectomy to examine costs and readmissions following early discharge. Methods All adults undergoing elective colectomy for primary colon cancer were identified in the 2016–2019 Nationwide Readmissions Database. Patients with perioperative complications or prolonged length of stay (>8 days) were excluded to enhance cohort homogeneity. Patients discharged by postoperative day 3 were classified as Early, and others as Routine. Entropy balancing and multivariable regression were used to assess the risk-adjusted association of early discharge with costs and non-elective readmissions. Importantly, we compared 90-day stroke rates to examine whether our results were influenced by preferential early discharge of healthier patients. Results Of an estimated 153,996 patients, 45.5% comprised the Early cohort. Compared to Routine, the Early cohort was younger and more commonly male. Patients in the Early group more commonly underwent left-sided colectomy and laparoscopic operations. Following multivariable adjustment, expedited discharge was associated with a $4,500 reduction in costs as well as lower 30-day (adjusted odds ratio [AOR] 0.74, p<0.001) and 90-day non-elective readmissions (AOR 0.74, p<0.001). However, among those readmitted within 90 days, Early patients were more commonly readmitted for gastrointestinal conditions (45.8 vs 36.4%, p<0.001). Importantly, both cohorts had comparable 90-day stroke rates (2.2 vs 2.1%, p = 0.80). Conclusions The present work represents the largest analysis of early discharge following colectomy for cancer and supports its relative safety and cost-effectiveness.

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