Relation of Length of Stay to Unplanned Readmissions for Patients Who Undergo Elective Percutaneous Coronary Intervention
December 13, 2019
THE HEALTH ECONOMICS QUESTION STUDIED
The cost of inpatient percutaneous coronary intervention (PCI) is related to length of stay (LOS). However, it is not known if LOS is associated with readmission rates and costs of index PCI plus readmissions in elective PCI. This study aims evaluated the rates, predictors, causes, and costs associated with 30-day unplanned readmissions according to LOS in patients who underwent elective PCI.
The study included patients enrolled in the Nationwide Readmission Database (a nationally representative sample of all-age, all-payer discharges from US nonfederal hospitals), who were admitted to a hospital from 2010 to 2014, and who underwent uncomplicated elective PCI. LOS was defined as 0, 1, 2, and ≥3 days. A total of 324,345 patients were included in the analysis and the 30-day unplanned readmission was 4.75%, 4.67%, 6.44%, and 9.42% in the LOS groups 0, 1, 2, and ≥3 days, respectively.
Compared with 0 days, the odds of readmissions were greater for
2 days (OR 1.41, 95% CI 1.07 to 1.87, p = 0.016) and ≥3 days (OR 1.70, 95% CI 1.28 to 2.24, p <0.001).
Prolonged LOS was associated with increased average total
30-day cost (index and readmission cost, 0 days $15,063, 1 day $14,693, 2 days $18,136, and ≥3 days $24,336).
Statistically signiﬁcant SDD increase was observed with the proportion of cases in which the LOS was 1 day decreased over time.
Comorbidities and risk factors were strong predictors of LOS. Irrespective of the LOS, the most frequent cause of cardiac readmission was chest pain (lower post-procedural threshold) and 60 % of all readmissions are for noncardiac causes.
Prolonged LOS in hospital was associated with higher rates of readmission for heart failure (LOS 0 days 3.9%, 1 day 4.6%, 2 days 7.8%, and ≥3 days
HEALTH ECONOMICS IMPLICATIONS
This analysis suggests that same-day-discharge and shorter lengths of stay in elective patients are not associated with increased rates of unplanned readmission and that the savings achieved with shorter LOS are not offset by increased total healthcare cost for 30-days driven by unplanned readmissions. Longer LOS was associated with reduced incidence of readmissions for noncardiac causes such as noncardiac chest pain, but a greater rate of readmissions for heart failure.
About the Author
Sr. Strategic Business Account Manager
Terumo Health Outcomes
As Strategic Business Account Manager, John assists hospitals in understanding the full financial impact of their care pathway redesign and their ROI. John earned a Master’s Degree in Business from Montclair State University, and has spent over 15 years in the health care fields of cardiology, electrophysiology, orthopedics, and diagnostic imaging. He has worked closely with hospital leadership to develop programs focused on the economic costs of healthcare procedures, including initiating radial adoption, creating reprocessing initiatives and establishing value-based contracts.