Effect of early discharge after surgery on costs

Editor's Note

Early postoperative discharge after major inpatient surgery was associated with lower total surgical episode payments in this study.

In this analysis of 639,943 Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting (CABG), or total hip replacement, payments were significantly lower in hospitals with lowest vs highest length of stay (LOS):

• $26,482 vs $29,250 for colectomy
• $44,777 vs $47,675 for CABG
• $24,553 vs $27,927 for total hip.

There was no evidence that savings from shorter postoperative LOS was offset by higher spending for postdischarge care and readmissions, respectively:

• $4,011 vs $5,083 and $2,606 vs $2,887 for colectomy
• $6,015 vs $6,355 and $3,175 vs $3,064 for CABG
• $7,132 vs $9,552 and $1,373 vs $1,514 for total hip.

The findings show that accelerated discharge protocols align well with incentives to reduce overall spending, the authors say.

Question Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care?