Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Collected
2.3. Statistical Analysis
3. Results
3.1. Characteristics of the Sample
3.2. Factors Associated with an Increased LOS
3.3. Factors Associated with Discharge with Need for Additional Care
4. Discussion
4.1. Discussion of Findings
4.2. Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Gonçalves-Bradley, D.C.; Lannin, N.A.; Clemson, L.M.; Cameron, I.D.; Shepperd, S. Discharge planning from hospital. Cochrane Database Syst. Rev. 2016. [Google Scholar] [CrossRef]
- Campbell, R.C.; Dudley, H.A. Hospital stay of patients undergoing minor surgical procedures. Lancet Lond. Engl. 1964, 2, 403–405. [Google Scholar] [CrossRef]
- Bithell, J.F.; Devlin, H.B. Prediction of discharge of hospital inpatients. Health Serv. Res. 1968, 3, 174–184. [Google Scholar]
- Anderson, A.D.G.; McNaught, C.E.; MacFie, J.; Tring, I.; Barker, P.; Mitchell, C.J. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br. J. Surg. 2003, 90, 1497–1504. [Google Scholar] [CrossRef]
- Morgan, M.; Beech, R. Variations in lengths of stay and rates of day case surgery: Implications for the efficiency of surgical management. J. Epidemiol. Commun. Health 1990, 44, 90–105. [Google Scholar] [CrossRef] [Green Version]
- De Saint-Hubert, M.; Schoevaerdts, D.; Cornette, P.; D’Hoore, W.; Boland, B.; Swine, C. Predicting functional adverse outcomes in hospitalized older patients: A systematic review of screening tools. J. Nutr. Health Aging 2010, 14, 394–399. [Google Scholar] [CrossRef] [PubMed]
- Oldmeadow, L.B.; McBurney, H.; Robertson, V.J. Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty. J. Arthroplast. 2003, 18, 775–779. [Google Scholar] [CrossRef]
- Parsonnet, V.; Dean, D.; Bernstein, A.D. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989, 79 Pt 2, I3–I12. [Google Scholar]
- Copeland, G.P.; Jones, D.; Walters, M. POSSUM: A scoring system for surgical audit. Br. J. Surg. 1991, 78, 355–360. [Google Scholar] [CrossRef]
- Zarovska, A.; Evangelista, A.; Boccia, T.; Ciccone, G.; Coggiola, D.; Scarmozzino, A.; Corsi, D. Development and validation of a simplified BRASS index to screen hospital patients needing personalized discharge planning. J. Gen. Intern. Med. 2018, 33, 1084–1091. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wiley, M.M. Diagnosis related groups (DRGs): Measuring hospital case mix. In Wiley StatsRef: Statistics Reference Online; Balakrishnan, N., Colton, T., Everitt, B., Piegorsch, W., Ruggeri, F., Teugels, J.L., Eds.; American Cancer Society: Atlanta, GA, USA, 2014. [Google Scholar]
- Robinson, G.H.; Davis, L.E.; Leifer, R.P. Prediction of hospital length of stay. Health Serv. Res. 1966, 1, 287–300. [Google Scholar] [PubMed]
- Kobewka, D.M.; Mulpuru, S.; Chassé, M.; Thavorn, K.; Lavallée, L.T.; English, S.W.; Neilipovitz, B.; Neilipovitz, J.; Forster, A.J.; McIsaac, D.I. Predicting the need for supportive services after discharged from hospital: A systematic review. BMC Health Serv. Res. 2020, 20, 161. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Department of Health. Achieving Timely ‘Simple’ Discharge from Hospital: A Toolkit for the Multi-Disciplinary Team. 2004. Available online: http://europepmc.org/guidelines/HIR/59852 (accessed on 29 October 2020).
- Safavi, K.C.; Khaniyev, T.; Copenhaver, M.; Seelen, M.; Langle, A.C.Z.; Zanger, J.; Daily, B.; Levi, R.; Dunn, P. Development and validation of a machine learning model to aid discharge processes for inpatient surgical care. JAMA Netw. Open 2019, 2, e1917221. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pecoraro, F.; Clemente, F.; Luzi, D. The efficiency in the ordinary hospital bed management in Italy: An in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak. PLoS ONE 2020, 15, e0239249. [Google Scholar] [CrossRef] [PubMed]
- Aceto, P.; Incalzi, R.A.; Bettelli, G.; Carron, M.; Chiumiento, F.; Corcione, A.; Crucitti, A.; Maggi, S.; Montorsi, M.; Pace, M.C.; et al. Perioperative management of elderly patients (PriME): Recommendations from an Italian intersociety consensus. Aging Clin. Exp. Res. 2020, 32, 1647–1673. [Google Scholar] [CrossRef] [PubMed]
- Lin, H.-S.; Watts, J.N.; Peel, N.M.; Hubbard, R.E. Frailty and post-operative outcomes in older surgical patients: A systematic review. BMC Geriatr. 2016, 16, 157. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- George, E.L.; Arya, S. The importance of incorporating frailty screening into surgical clinical workflow. JAMA Netw. Open 2019, 2, e193538. [Google Scholar] [CrossRef] [Green Version]
- Havens, J.M.; Peetz, A.B.; Do, W.S.; Cooper, Z.; Kelly, E.; Askari, R.; Reznor, G.; Salim, A. The excess morbidity and mortality of emergency general surgery. J. Trauma Acute Care Surg. 2015, 78, 306–311. [Google Scholar] [CrossRef]
- Achanta, A.; Nordestgaard, A.; Kongkaewpaisan, N.; Han, K.R.; Mendoza, A.; Saillant, N.; Rosenthal, M.; Fagenholz, P.; Velmahos, G.; Kaafarani, H. Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care. J. Trauma Acute Care Surg. 2019, 87, 408–412. [Google Scholar] [CrossRef]
- McAleese, P.; Odling-Smee, W. The effect of complications on length of stay. Ann. Surg. 1994, 220, 740–744. [Google Scholar] [CrossRef]
- Pirson, M.; Dehanne, F.; van den Bulcke, J.; Leclercq, P.; Martins, D.; de Wever, A. Evaluation of cost and length of stay, linked to complications associated with major surgical procedures. Acta Clin. Belg. 2018, 73, 40–49. [Google Scholar] [CrossRef] [PubMed]
- Shahrokni, A.; Tin, A.; Alexander, K.; Sarraf, S.; Afonso, A.; Filippova, O.; Harris, J.; Downey, R.J.; Vickers, A.J.; Korc-Grodzicki, B. Development and evaluation of a new frailty index for older surgical patients with cancer. JAMA Netw. Open 2019, 2, e193545. [Google Scholar] [CrossRef] [PubMed]
Period 1 | Period 2 | ||||||||
---|---|---|---|---|---|---|---|---|---|
n = 15,165 | n = 388 | ||||||||
Variable | Whole | By Discharge Destination | p | LOS co | p | Whole | |||
Deceased | No NAC | NAC | |||||||
Age co | 62 (22) | 78 (16) | 61 (22) | 71 (21) | <0.001 | 0.08 | <0.001 | 61 (20) | |
LOS co | 3 (6) | 19 (26) | 3 (6) | 15 (30) | <0.001 | - | - | 2 (3) | |
Sex | Female | 47.7 | 0.4 | 97.3 | 2.3 | 0.069 | 3 (6) | 0.388 | 45.9 |
Male | 52.3 | 0.6 | 96.7 | 2.7 | 3 (7) | 54.1 | |||
Place of residence | Same region | 90.4 | 0.5 | 97 | 2.5 | 0.076 | 3(6) | 0.004 | 95.4 |
Other region | 9.4 | 0.2 | 97.1 | 2.7 | 4 (8) | 4.6 | |||
Abroad | 0.2 | 3.6 | 92.8 | 3.6 | 5 (12) | - | |||
Hospitalization procedure | Planned | 68.9 | 0.1 | 98.3 | 1.6 | <0.001 | 1 (4) | <0.001 | 90.2 |
ED | 18.7 | 1.8 | 94.1 | 4.1 | 7 (10) | 1.8 | |||
Other | 12.4 | 0.6 | 94.4 | 5 | 6 (10) | <0.001 | 8 | ||
Neoplasia | Yes | 25.6 | 1.1 | 95 | 3.9 | <0.001 | 7 (13) | 17.8 | |
No | 74.4 | 0.3 | 97.7 | 2 | 2 (5) | 82.2 | |||
Discharge destination | Deceased | 0.5 | - | - | - | - | - | ||
No NAC | 97 | - | - | - | - | - | |||
NAC | 2.5 | - | - | - | - | - | |||
DRG—weight > 1 | Yes | 53.1 | 0.8 | 95.5 | 3.7 | <0.001 | 6 (9) | <0.001 | - |
No | 46.9 | 0.1 | 98.8 | 1.1 | 1 (2) | - | |||
DRG—with complications | Yes | 18.9 | 1.9 | 91.5 | 6.6 | <0.001 | 9 (12) | <0.001 | - |
No | 81.1 | 0.2 | 98.3 | 1.5 | 2 (5) | - | |||
Caregiver > 65 y/o or no caregiver | Yes | - | - | - | - | - | 68.8 | ||
No | - | - | - | - | - | 31.2 | |||
Smoking | Yes | - | - | - | - | - | 21 | ||
No | - | - | - | - | - | 79 | |||
Living alone | Yes | - | - | - | - | - | 17.6 | ||
No | - | - | - | - | - | 82.4 | |||
Fall in the preceding year | Yes | - | - | - | - | - | 10.4 | ||
No | - | - | - | - | - | 89.6 | |||
Walking aid need | Yes | - | - | - | - | - | 2.9 | ||
No | - | - | - | - | - | 97.1 |
Variable | Period 1—All Variables | Period 1—At Admission | Period 2 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
B | 95% CI | p | B | 95% CI | p | B | 95% CI | p | ||
Age co | 0.04 | 0.03; 0.05 | <0.001 | 0.08 | 0.07;0.08 | <0.001 | 0.03 | 0.01; 0.05 | 0.017 | |
Sex—Female | 0.07 | −0.19; 0.34 | 0.585 | −0.16 | −0.46;0.13 | 0.273 | −0.04 | −0.70; 0.62 | 0.908 | |
Place of residence | Same region | Ref. | - | - | Ref. | - | - | Ref. | - | - |
Other region | −0.10 | −0.56; 0.35 | 0.661 | 0.93 | 0.42;1.43 | <0.001 | 1.11 | −0.34; 2.55 | 0.133 | |
Abroad | −0.77 | −4.32; 2.77 | 0.668 | 0.41 | −3.53;4.36 | 0.837 | - | - | - | |
Hospitalization procedure | Planned | Ref. | - | - | Ref. | - | - | Ref. | - | - |
ED | 5.21 | 4.85; 5.57 | <0.001 | 6.92 | 6.54;7.30 | <0.001 | 8.22 | 5.94; 10.50 | <0.001 | |
Other | 4.32 | 3.90; 4.73 | <0.001 | 6.44 | 5.99;6.90 | <0.001 | −0.29 | −1.47; 0.89 | 0.631 | |
Neoplasia presence | 2.57 | 2.24; 2.90 | <0.001 | - | - | - | 3.49 | 2.65; 4.32 | <0.001 | |
Discharge destination | No NAC | Ref. | - | - | - | - | - | - | - | - |
Deceased | 9.78 | 7.86; 11.70 | <0.001 | - | - | - | - | - | - | |
NAC | 10.76 | 9.90; 11.62 | <0.001 | - | - | - | - | - | - | |
DRG—weight > 1 | 4.32 | 4.01; 4.63 | <0.001 | - | - | - | - | - | - | |
DRG—with complications | 3.68 | 3.30; 4.06 | <0.001 | - | - | - | - | - | - | |
Caregiver > 65 y/o or no caregiver | - | - | - | - | - | −0.60 | −1.32; 0.11 | 0.099 | ||
Smoking | - | - | - | - | - | 0.04 | −0.74; 0.82 | 0.925 | ||
Living alone | - | - | - | - | - | 0.03 | −0.80; 0.87 | 0.935 | ||
Fall in the preceding year | - | - | - | - | - | −0.02 | −1.05; 1.02 | 0.969 | ||
Walking aid need | - | - | - | - | - | −0.26 | −2.20; 1.68 | 0.792 |
Variable | Period 1—All Variables | Period 1—At Admission | |||||
---|---|---|---|---|---|---|---|
OR | 95% CI | p | OR | 95%CI | p | ||
Age | 1.02 | 1.01; 1.03 | <0.001 | 1.03 | 1.02;1.03 | <0.001 | |
Sex—Female | 0.97 | 0.79; 1.20 | 0.792 | 0.92 | 0.75;1.14 | 0.445 | |
Place of residence | Same region | Ref. | - | - | Ref. | - | - |
Other region | 0.95 | 0.67; 1.34 | 0.783 | 1.09 | 0.77;1.53 | 0.625 | |
Abroad | 1.22 | 0.16; 9.36 | 0.849 | 1.47 | 0.19;11.01 | 0.710 | |
Hospitalization procedure | Planned | Ref. | - | - | Ref. | - | - |
ED | 1.77 | 1.37; 2.30 | <0.001 | 2.54 | 1.99;3.24 | <0.001 | |
Other | 2.69 | 2.06; 3.51 | <0.001 | 3.39 | 2.61;4.40 | <0.001 | |
Neoplasia presence | 1.24 | 0.98; 1.56 | 0.076 | - | - | - | |
DRG—weight > 1 | 1.65 | 1.23; 2.22 | 0.001 | - | - | - | |
DRG—with complications | 1.02 | 1.01; 1.03 | <0.001 | - | - | - |
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Bert, F.; Kakaa, O.; Corradi, A.; Mascaro, A.; Roggero, S.; Corsi, D.; Scarmozzino, A.; Siliquini, R. Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study. Int. J. Environ. Res. Public Health 2020, 17, 9490. https://doi.org/10.3390/ijerph17249490
Bert F, Kakaa O, Corradi A, Mascaro A, Roggero S, Corsi D, Scarmozzino A, Siliquini R. Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study. International Journal of Environmental Research and Public Health. 2020; 17(24):9490. https://doi.org/10.3390/ijerph17249490
Chicago/Turabian StyleBert, Fabrizio, Omar Kakaa, Alessio Corradi, Annamaria Mascaro, Stefano Roggero, Daniela Corsi, Antonio Scarmozzino, and Roberta Siliquini. 2020. "Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study" International Journal of Environmental Research and Public Health 17, no. 24: 9490. https://doi.org/10.3390/ijerph17249490