National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy
Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases. We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospita...
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| Veröffentlicht in: | The American journal of surgery 2025-01, Vol.239, p.116021, Article 116021 |
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| creator | Rafaqat, Wardah Janjua, Mahin Mahmud, Omar James, Bradford Khan, Baryalay Lee, Hanjo Khan, Aimal |
| description | Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases.
We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.
SDD patients had lower comorbidity (33 % vs 21 %) and illness severity (79 % vs 63 %), more Medicare insurance (44 % vs 38 %), and more benign neoplasms (52 % vs 17 %). Most SDD patients underwent right colectomy (89 %). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p |
| doi_str_mv | 10.1016/j.amjsurg.2024.116021 |
| format | Article |
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We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.
SDD patients had lower comorbidity (33 % vs 21 %) and illness severity (79 % vs 63 %), more Medicare insurance (44 % vs 38 %), and more benign neoplasms (52 % vs 17 %). Most SDD patients underwent right colectomy (89 %). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p < 0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged.
SDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.
•Same day discharge after minimally invasive colectomy is safe for some patients.•Studies to capture its impact on cost are lacking.•We compared same-day discharge versus short stay in 647 propensity matched pairs.•Total costs after same day discharge were 38 % lower due to cheaper index hospitalization.•A significant uptrend in annual rates of same day discharge was seen.</description><identifier>ISSN: 0002-9610</identifier><identifier>ISSN: 1879-1883</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2024.116021</identifier><identifier>PMID: 39426119</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Ambulatory colectomy ; Ambulatory surgery ; Colectomy ; Colectomy - economics ; Comorbidity ; Cost ; Cost control ; Cost reduction ; Diagnosis related groups ; DRGs ; Elective Surgical Procedures - economics ; Elective Surgical Procedures - statistics & numerical data ; Enhanced Recovery After Surgery ; Event-related potentials ; Female ; Hospital Costs - statistics & numerical data ; Hospital Costs - trends ; Hospitalization ; Hospitals ; Humans ; Impact analysis ; Length of stay ; Length of Stay - economics ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Minimally invasive surgery ; Minimally Invasive Surgical Procedures - economics ; Mortality ; Nationwide readmission database ; Neoplasms ; Patient Discharge - statistics & numerical data ; Patient Readmission - economics ; Patient Readmission - statistics & numerical data ; Patient Readmission - trends ; Patients ; Propensity Score ; Regression analysis ; Retrospective Studies ; Same day discharge ; Surgery ; Surgical outcomes ; Trends ; Tumors ; United States</subject><ispartof>The American journal of surgery, 2025-01, Vol.239, p.116021, Article 116021</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><rights>2024. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c271t-2d76885faa7370c9889f840bea8292f023e34c064698e343d95a6bd3661e3703</cites><orcidid>0000-0001-6514-1646 ; 0000-0002-0373-0784 ; 0000-0003-2851-8330</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961024005737$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39426119$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rafaqat, Wardah</creatorcontrib><creatorcontrib>Janjua, Mahin</creatorcontrib><creatorcontrib>Mahmud, Omar</creatorcontrib><creatorcontrib>James, Bradford</creatorcontrib><creatorcontrib>Khan, Baryalay</creatorcontrib><creatorcontrib>Lee, Hanjo</creatorcontrib><creatorcontrib>Khan, Aimal</creatorcontrib><title>National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases.
We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.
SDD patients had lower comorbidity (33 % vs 21 %) and illness severity (79 % vs 63 %), more Medicare insurance (44 % vs 38 %), and more benign neoplasms (52 % vs 17 %). Most SDD patients underwent right colectomy (89 %). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p < 0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged.
SDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.
•Same day discharge after minimally invasive colectomy is safe for some patients.•Studies to capture its impact on cost are lacking.•We compared same-day discharge versus short stay in 647 propensity matched pairs.•Total costs after same day discharge were 38 % lower due to cheaper index hospitalization.•A significant uptrend in annual rates of same day discharge was seen.</description><subject>Adult</subject><subject>Aged</subject><subject>Ambulatory colectomy</subject><subject>Ambulatory surgery</subject><subject>Colectomy</subject><subject>Colectomy - economics</subject><subject>Comorbidity</subject><subject>Cost</subject><subject>Cost control</subject><subject>Cost reduction</subject><subject>Diagnosis related groups</subject><subject>DRGs</subject><subject>Elective Surgical Procedures - economics</subject><subject>Elective Surgical Procedures - statistics & numerical data</subject><subject>Enhanced Recovery After Surgery</subject><subject>Event-related potentials</subject><subject>Female</subject><subject>Hospital Costs - statistics & numerical data</subject><subject>Hospital Costs - trends</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Impact analysis</subject><subject>Length of stay</subject><subject>Length of Stay - economics</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally invasive surgery</subject><subject>Minimally Invasive Surgical Procedures - economics</subject><subject>Mortality</subject><subject>Nationwide readmission database</subject><subject>Neoplasms</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Patient Readmission - economics</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Patient Readmission - trends</subject><subject>Patients</subject><subject>Propensity Score</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Same day discharge</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Trends</subject><subject>Tumors</subject><subject>United States</subject><issn>0002-9610</issn><issn>1879-1883</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUGPFCEQhYnRuLOrP0FD4sVLjxT00HAyZqOuyUYveycMVI90umGE7knm30tnRg9ePAHF96rgPULeANsCA_lh2NppKEs-bDnj7RZAMg7PyAZUpxtQSjwnG8YYb7QEdkNuSxnqEaAVL8mN0C2XAHpDxu92Dinakc4Zoy_URk9dKnOhqafFTki9PVMfivtp8wFpiPRYJRgrsUSP-ZBCPFAc0c3hhHQKMUx2HM-VPNmyllxaL9N0fkVe9HYs-Pq63pGnL5-f7h-axx9fv91_emwc72BuuO-kUrve2k50zGmldK9atkeruOY94wJF65hspVZ1J7zeWbn3QkrAKhB35P2l7TGnXwuW2Uz1-TiONmJaihEAqu2Y3PGKvvsHHdKSqx0r1QrF62xdqd2FcjmVkrE3x1w_mc8GmFnTMIO5pmHWNMwljap7e-2-7Cf0f1V_7K_AxwuA1Y1TwGyKq9Y69CFXy4xP4T8jfgP-y53o</recordid><startdate>202501</startdate><enddate>202501</enddate><creator>Rafaqat, Wardah</creator><creator>Janjua, Mahin</creator><creator>Mahmud, Omar</creator><creator>James, Bradford</creator><creator>Khan, Baryalay</creator><creator>Lee, Hanjo</creator><creator>Khan, Aimal</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6514-1646</orcidid><orcidid>https://orcid.org/0000-0002-0373-0784</orcidid><orcidid>https://orcid.org/0000-0003-2851-8330</orcidid></search><sort><creationdate>202501</creationdate><title>National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy</title><author>Rafaqat, Wardah ; Janjua, Mahin ; Mahmud, Omar ; James, Bradford ; Khan, Baryalay ; Lee, Hanjo ; Khan, Aimal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c271t-2d76885faa7370c9889f840bea8292f023e34c064698e343d95a6bd3661e3703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Ambulatory colectomy</topic><topic>Ambulatory surgery</topic><topic>Colectomy</topic><topic>Colectomy - economics</topic><topic>Comorbidity</topic><topic>Cost</topic><topic>Cost control</topic><topic>Cost reduction</topic><topic>Diagnosis related groups</topic><topic>DRGs</topic><topic>Elective Surgical Procedures - economics</topic><topic>Elective Surgical Procedures - statistics & numerical data</topic><topic>Enhanced Recovery After Surgery</topic><topic>Event-related potentials</topic><topic>Female</topic><topic>Hospital Costs - statistics & numerical data</topic><topic>Hospital Costs - trends</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Impact analysis</topic><topic>Length of stay</topic><topic>Length of Stay - economics</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally invasive surgery</topic><topic>Minimally Invasive Surgical Procedures - economics</topic><topic>Mortality</topic><topic>Nationwide readmission database</topic><topic>Neoplasms</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Patient Readmission - economics</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Patient Readmission - trends</topic><topic>Patients</topic><topic>Propensity Score</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Same day discharge</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Trends</topic><topic>Tumors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rafaqat, Wardah</creatorcontrib><creatorcontrib>Janjua, Mahin</creatorcontrib><creatorcontrib>Mahmud, Omar</creatorcontrib><creatorcontrib>James, Bradford</creatorcontrib><creatorcontrib>Khan, Baryalay</creatorcontrib><creatorcontrib>Lee, Hanjo</creatorcontrib><creatorcontrib>Khan, Aimal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rafaqat, Wardah</au><au>Janjua, Mahin</au><au>Mahmud, Omar</au><au>James, Bradford</au><au>Khan, Baryalay</au><au>Lee, Hanjo</au><au>Khan, Aimal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2025-01</date><risdate>2025</risdate><volume>239</volume><spage>116021</spage><pages>116021-</pages><artnum>116021</artnum><issn>0002-9610</issn><issn>1879-1883</issn><eissn>1879-1883</eissn><abstract>Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases.
We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.
SDD patients had lower comorbidity (33 % vs 21 %) and illness severity (79 % vs 63 %), more Medicare insurance (44 % vs 38 %), and more benign neoplasms (52 % vs 17 %). Most SDD patients underwent right colectomy (89 %). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p < 0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged.
SDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.
•Same day discharge after minimally invasive colectomy is safe for some patients.•Studies to capture its impact on cost are lacking.•We compared same-day discharge versus short stay in 647 propensity matched pairs.•Total costs after same day discharge were 38 % lower due to cheaper index hospitalization.•A significant uptrend in annual rates of same day discharge was seen.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39426119</pmid><doi>10.1016/j.amjsurg.2024.116021</doi><orcidid>https://orcid.org/0000-0001-6514-1646</orcidid><orcidid>https://orcid.org/0000-0002-0373-0784</orcidid><orcidid>https://orcid.org/0000-0003-2851-8330</orcidid></addata></record> |
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| subjects | Adult Aged Ambulatory colectomy Ambulatory surgery Colectomy Colectomy - economics Comorbidity Cost Cost control Cost reduction Diagnosis related groups DRGs Elective Surgical Procedures - economics Elective Surgical Procedures - statistics & numerical data Enhanced Recovery After Surgery Event-related potentials Female Hospital Costs - statistics & numerical data Hospital Costs - trends Hospitalization Hospitals Humans Impact analysis Length of stay Length of Stay - economics Length of Stay - statistics & numerical data Male Middle Aged Minimally invasive surgery Minimally Invasive Surgical Procedures - economics Mortality Nationwide readmission database Neoplasms Patient Discharge - statistics & numerical data Patient Readmission - economics Patient Readmission - statistics & numerical data Patient Readmission - trends Patients Propensity Score Regression analysis Retrospective Studies Same day discharge Surgery Surgical outcomes Trends Tumors United States |
| title | National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy |
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