ANALYSIS OF HOSPITAL COSTS BY DAY OF ADMISSION IN PATIENTS UNDERGOING COMMON SURGICAL PROCEDURES IN THE UNITED STATES

OBJECTIVES: Shortening length of stay (LOS) following inpatient surgery may reduce hospital costs, but quantifying cost savings requires isolation of the fixed surgery costs typically incurred on hospital Day 1 from variable costs incurred on subsequent days. We aimed to describe cost per day of hospital admission in patients undergoing inpatient surgical procedures. METHODS: We evaluated data available via the Premier Perspective® Database which includes administrative data from more than 600 hospitals in the United States. Data on discharges from 10/1/2014 to 9/30/15 with a primary ICD-9 procedure code for one of the 10 most common surgical procedures performed in adults (total knee and hip replacement; laparoscopic cholecystectomy and appendectomy; cervical fusion; open fracture reduction of the femur and tibia/fibula; lumbar/sacral fusion; total abdominal hysterectomy; and excisional wound/burn debridement) were included. Maternal or neonatal hospitalizations and those with any intensive care unit stay were excluded. The primary outcome was daily total hospital cost, stratified by day of hospital admission and surgical procedure. AH outcomes were summarized descriptively using means and standard deviations. RESULTS: A total of 307,236 hospital discharges of interest occurred during the study period. Total daily costs in all surgeries were highest on the first day of admission (Day 1) and declined thereafter. The differences in total hospital costs for the first 3 days of hospitalization were most pronounced in lumbar/sacral fusion ($23,749, $1862, and $1359 on Days 1, 2, and 3) and cervical fusion ($13,914, $1174, and $1453). Total costs on Day 3 were less than $1500 for all surgeries except laparoscopic cholecystectomy ($2132) and open fracture reduction of the femur ($2794) and tibia/fibula ($1936). CONCLUSIONS: Hospital costs in surgical patients were heavily weighted toward the first day of admission. Shortening LOS by one full day could reduce total hospital costs by up to $2794, depending on the type of surgery.