Surgical Episode Costs Lower for Hospitals that Discharge Earlier

Hospitals with shorter postoperative length of stays did not have higher postdischarge care use or readmissions, according to a study published in the online JAMA Surgery. In fact, their total overall surgical episode costs were lower compared with hospitals with longer postoperative stays.

“Therefore,” researchers wrote, “accelerated postoperative care protocols appear well aligned with the goals of bundled payment initiatives for surgical episodes.”

The study, which looked at spending among hospitals with shorter and longer postoperative stays, focused on 3 common inpatient operations among older adults: colectomy, coronary artery bypass grafting, and total hip replacement. Nearly 640,000 Medicare beneficiaries who received surgery between January 1, 2009, and June 30, 2012, were included in the analysis.

Researchers aimed to determine whether cost savings from shorter hospitalizations were offset by increases in postdischarge costs and readmissions.

Total surgical episode payments, however, were significantly lower among hospitals with shorter length of stays. Furthermore, researchers found no evidence of compensatory payment increases for patients’ postdischarge care.

Hospitals with shorter postoperative stays had greater surgical procedure volumes and lower rates of complications, researchers pointed out. In the case of colectomy, they were also substantially more likely to use minimally invasive laparoscopic techniques.

“Our findings suggest that accelerated discharge may be a characteristic of high-quality inpatient surgical care and indicate that it may be achieved in appropriate settings without unwarranted spending afterward,” researchers wrote. “Whether hospitals with high length-of-stay practices would ameliorate clinical and economic outcomes by shortening length of stay alone is unclear.”—Jolynn Tumolo