ArticleJournal of vascular surgery2013
Early discharge does not increase readmission or mortality after high-risk vascular surgery.
Article in Journal of vascular surgery, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- General and vascular surgery readmissions: a systematic review.Journal of the American College of Surgeons · 2014Pooled it
- Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial.BMC geriatrics · 2020Trial
- CHANGES IN PACKED CELL VOLUME AFTER GYNAECOLOGICAL SURGERIES: A COMPARISON OF DAY 1 AND DAY 2 VALUES.Annals of Ibadan postgraduate medicine · 2025Article
- The Needs of Orthopaedic Patients in Discharge Planning.Malaysian orthopaedic journal · 2022Article
- Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management.Annals of vascular diseases · 2022Article
- Establishing and maintaining a remote vascular surgery aortic program: A single-center 5-year experience at the Veterans Affairs.Journal of vascular surgery · 2022Article
- Article
- The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2018Article
- Strategies to minimize readmission rates following major urologic surgery.Therapeutic advances in urology · 2017Review
- Assessment of length of stay in a general surgical unit using a zero-inflated generalized Poisson regression.Medical journal of the Islamic Republic of Iran · 2017Article
- Article
- Effectiveness of an intermediate care hospital on readmissions, mortality, activities of daily living and use of health care services among hospitalized adults aged 60 years and older--a controlled observational study.BMC health services research · 2015Observational
- Article
- Risk factors for readmission after lower extremity bypass in the American College of Surgeons National Surgery Quality Improvement Program.Journal of vascular surgery · 2014Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
purposeClinical pathways aimed at reducing hospital length of stay following vascular surgery have been broadly implemented to reduce costs. However, early hospital discharge may adversely affect the risk of readmission or mortality. To address this question, we examined the relationship between early discharge and 30-day outcomes among patients undergoing a high-risk vascular surgery procedure, thoracic aortic aneurysm (TAA) repair.
methodsUsing Medicare claims from 2000 to 2007, we identified all patients who were discharged home following elective thoracic endovascular aneurysm repair (TEVAR) and open repair for nonruptured TAAs. For each procedure, we examined the correlation between early discharge (<3 days for TEVAR, <7 days for open TAA repair) and 30-day readmission, 30-day mortality, and hospital costs. Predictors of readmission were evaluated using logistic regression models controlling for patient comorbidities, perioperative complications, and discharge location.
resultsOur sample included 9764 patients, of which 7850 (80%) underwent open TAA repair, and 1914 (20%) underwent TEVAR. Patients discharged to home early were more likely to be female (66% early vs 56% late), Caucasian (94% early vs 91% late), younger (73 years early vs 74 years late), and have fewer comorbidities (mean Charlson score: 0.7 early vs 1.0 late) than patients discharged home late (all P < .01). As compared with patients who were discharged late, patients discharged home early following uncomplicated open TAA repair and TEVAR had significantly lower 30-day readmission rates ([open: 17% vs 24%; P < .001] [TEVAR: 12% vs 23%; P < .001]) and hospital costs ([open: $73,061 vs $136,480; P < .001] [TEVAR: $58,667 vs $128,478; P < .001]), without an observed increase in 30-day postdischarge mortality. In multivariable analysis, early hospital discharge was associated with a significantly lower likelihood of readmission following both open TAA repair (odds ratio, 0.70; 95% confidence interval, 0.57-0.85; P < .001) and TEVAR (odds ratio, 0.57; 95% confidence interval, 0.38-0.85; P < .01) procedures.
conclusionsDischarging patients home early following uncomplicated TEVAR or open TAA repair is associated with reduced hospital costs without adversely impacting 30-day readmission or mortality rates. These data support the safety and cost-effectiveness of programs aimed at early hospital discharge in selected vascular surgery patients.
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