Cost Consequences of Age and Comorbidity in Accelerated Postoperative Discharge After Colectomy

BACKGROUND: Prospective payment models have incentivized reductions in length of stay after surgery. The benefits of abbreviated postoperative hospitalization could be undermined by increased readmissions or postacute care use, particularly for older adults or those with comorbid conditions. OBJECTIVE: The purpose of this study was to determine whether hospitals with accelerated postsurgical discharge accrue total episode savings or incur greater postdischarge payments among patients stratified by age and comorbidity. DESIGN: This was a retrospective cross-sectional study. SETTING: National data from the 100% Medicare Provider Analysis and Review files for July 2012 to June 2015 were used. PATIENTS: We included Medicare beneficiaries undergoing elective colectomy and stratified the cohort by age (65–69, 70–79, ≥80 y) and Elixhauser comorbidity score (low: ≤0; medium: 1–5; and high:>5). Patients were categorized by the hospital’s mode length of stay, reflecting “usual” care. MAIN OUTCOMES MEASURES: In a multilevel model, we compared mean total episode payments and components thereof among age and comorbidity categories, stratified by hospital mode length of stay. RESULTS: Among 88,860 patients, mean total episode payments were lower in shortest versus longest length of stay hospitals across all age and comorbidity strata and were similar between age groups (65–69 y: $28,951 vs $30,566, p = 0.014; 70–79 y: $31,15...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Outcomes Source Type: research