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Same day discharge colon surgery: is it financially worth it?
Karleigh R Curfman1, Gabrielle E Blair2, Callan L Kosnik1
1MultiCare Health Network, Tacoma, Washington, USA.
Insights
Same day discharge (SDD) for colorectal surgery significantly reduces hospital costs compared to postoperative day 1 (POD1) discharge. Clinical outcomes and contribution margins remain comparable between the two discharge strategies.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Healthcare Economics
Background:
- Enhanced recovery after surgery protocols and minimally invasive techniques have increased the feasibility of same day discharge (SDD) for colorectal surgery.
- The COVID-19 pandemic further highlighted the need for efficient hospital resource utilization, making SDD a relevant consideration.
Purpose of the Study:
- To compare clinical outcomes and financial impacts of same day discharge (SDD) versus postoperative day 1 (POD1) discharge for colorectal surgery.
- To analyze differences in cost, charge, revenue, and contribution margin between SDD and POD1 discharge groups.
Main Methods:
- A retrospective review of 143 colectomy patients over a 2-year period.
- Patients were divided into two groups: SDD (n=51) and POD1 discharge (n=92).
- Data was analyzed using International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) and Diagnosis Related Grouper (DRG) codes.
Main Results:
- SDD was associated with statistically significant lower total hospital costs ($8699 vs. $11,652) and average charges ($85,506 vs. $97,008) compared to POD1 discharge.
- No statistically significant differences were found in net revenue, contribution margin, operating room time, robotic console time, readmission rates, or surgical complications between the groups.
- SDD demonstrated a lower average hospital cost and charge, indicating potential financial benefits.
Conclusions:
- Same day discharge (SDD) for colorectal surgery is associated with reduced hospital costs and charges compared to postoperative day 1 (POD1) discharge.
- SDD offers comparable clinical outcomes, including readmission rates and surgical complications, to POD1 discharge.
- SDD presents a financially viable and clinically safe option for colorectal surgery patients, especially within pandemic-related constraints.
Aim:
Same day discharge (SDD) for colorectal surgery shows increasing promise in the era of enhanced recovery after surgery protocols and minimally invasive surgery. It has become increasingly relevant due to the constraints posed by the COVID-19 pandemic. The aim of this study was to compare SDD and postoperative day 1 (POD1) discharge to understand the clinical outcomes and financial impact on factors such as cost, charge, revenue, contribution margin and readmission.
Method:
A retrospective review of colectomies was performed at a single institution over a 2-year period (n = 143). Two populations were identified: SDD (n = 51) and POD1 (n = 92). Patients were selected by International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) and Diagnosis Related Grouper (DRG) codes.
Results:
There was a statistically significant difference favouring SDD in total hospital cost (p < 0.0001), average direct costs (p < 0.0001) and average charges (p < 0.0016). SDD average hospital costs were $8699 (values in USD throughout) compared with $11 652 for POD 1 (p < 0.0001), and average SDD hospital charges were $85 506 compared with $97 008 for POD1 (p < 0.0016). The net revenue for SDD was $22 319 while for POD1 it was $26 173 (p = 0.14). Upon comparison of contribution margins (SDD $13 620 vs. POD1 $14 522), the difference was not statistically significant (p = 0.73). There were no identified statistically significant differences in operating room time, robotic console time, readmission rates or surgical complications.
Conclusions:
Amidst the pandemic-related constraints, we found that SDD was associated with lower hospital costs and comparable contribution margins compared with POD1. Additionally, the study was unable to identify any significant difference between operating time, readmissions, and surgical complications when performing SDD.
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