Challenge of balancing duration of stay and readmissions in children's operation

Heather L. Short, Isaac Parakati, Kurt F. Heiss, Mark L. Wulkan, John F. Sweeney, Mehul V. Raval*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background Surgeons balance competing interests of minimizing duration of stay with readmissions. Complications that occur early after discharge often result in readmissions. This study examines the relationship between duration of stay, timing of complications, and readmission risk. Methods Cases from the 2012–2014 National Surgical Quality Improvement Project—Pediatric were organized into 30 procedural groups. Procedures where duration of stay approximated the median day of complication were identified. A theoretical model was applied to minimize readmissions by extending duration of stay. Results From 30 procedure groups, 3 were identified where duration of stay approximated median day of compilations: complicated appendectomy, antireflux operation, and abdominal operation without bowel resection. The complicated appendectomy readmission rate drops from 12.2% to 8.2%, increasing duration of stay from 3 to 8 days at the cost of 16,428 additional hospital days among 4,740 patients (3.5 days/patient). Readmission optimization tapers after duration of stay of 8 days. Similar findings were observed for antireflux operation and abdominal operation without bowel resection with readmission optimization at duration of stay of 5 days (2.6 days/patient) and 7 days (5.3 days/patient), respectively. Conclusion Our theoretical model aimed at balancing readmissions by extending duration of stay to capture early complications results in a substantial increase in hospital days illustrating the conflict between competing quality metrics and limited resources.

Original languageEnglish (US)
Pages (from-to)950-957
Number of pages8
JournalSurgery (United States)
Volume162
Issue number4
DOIs
StatePublished - Oct 2017

ASJC Scopus subject areas

  • Surgery

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