Same-Day Discharge Colon Surgery: Is It Financially Worth It?

Abstract

INTRODUCTION: Same day discharge (SDD) for colorectal surgery shows increasing promise in the era of enhanced recovery after surgery protocols and minimally invasive surgery. It has become increasingly relevant due to constraints of the COVID-19 pandemic. This study aims to identify the patient cost, institutional charges, net margin revenue, and contribution margins associated with SDD, and analyze financial benefits when compared with admission. METHODS: Retrospective review of colectomy performed at a single institution over a 2-year period assessed for clinical outcomes, cost, charges, and revenue. The data was divided between 2 populations, SDD and postoperative day 1 (POD1) discharge. In addition to financial data, other outcomes included readmission, complication, and operative time. RESULTS: There was a statistically significant difference favoring SDD over POD1 discharge in average: operating time (p = 0.00036), direct cost (p = 0.00000001), and charges (p = 0.00007711). SDD average patient cost were $9,186 USD compared with $11,698 USD for POD 1, and average hospital charges for SDD were $84,038 vs $97,566 for POD 1. Average net revenue was expectedly lower in SDD, $21,471, when compared with POD1, $26,719, however when comparing contribution margins (SDD $12,285 v POD1 $15,021), there was no statistically significant difference, p = 0.212. There were no statistically significant differences in readmission or operative complication between populations. CONCLUSION: Amidst pandemic-related resource constraints, we found that SDD was associated with lower patient cost and comparable contribution margin, without a significant difference in readmission and operative complication when compared with POD1 discharge.