Retrospective Identification of Barriers to On-Time Discharge in Common General Surgery Operations

Abstract

Introduction: Increased durations of hospital stays are associated with increased nosocomial infections, higher mortality rates, lower patient satisfaction, and increased cost. This study aimed to identify barriers to safe and on-time discharge. Methods: Data was collected from electronic health records for all elective surgeries performed at an academic medical center over the last 5 years. The top 4 operations were selected: coronary artery bypass graft surgery (CABG) (n = 342), video-assisted thoracoscopic surgery (VATS) (n = 216), cholecystectomy (n = 350), and ventral hernia repair (n = 153). The primary outcome is length of stay (LOS), specifically extended LOS. Extended LOS was defined by a longer LOS compared with the average LOS provided by the Medicare Severity Diagnosis Related Groups (MS-DRG). Results: There were 6,473 patients and 10,468 operations analyzed. Extended LOS represented 23% of cases. There was no association between extended LOS and demographics, payor type, or employment status. Disposition to short-term nursing facility was associated with extended LOS in CABG and VATS. Unemployed and retired patients were associated with extended LOS among cholecystectomy patients. Conclusion: We identified predictive factors (disposition to a skilled nursing facility, and employment status) contributing to extended LOS postoperatively. We suspect that referral processes, number of facilities, and selection biases associated with short-term nursing facilities are major contributors to extended LOS and improvements in these processes can improve outcomes while decreasing identified risks associated with longer hospital stays.