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Is Same Day Discharge Associated With Readmission After Orthognathic Surgery?
Tim T Wang1, Lang Liang2, Nicholas Wilken3
1Resident, Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
Background:
Same day discharge pathways have the potential to reduce health care expenditures and improve access to care for patients undergoing orthognathic surgery. However, the effect of same day discharge on safety and postoperative outcomes is poorly understood.
Purpose:
The purpose of this study was to measure the association between discharge pathway and 30-day hospital readmission, as well as evaluate trends in same day discharge over time in patients undergoing orthognathic surgery.
Study Design, Setting Sample:
This was a retrospective cohort study using the 2011 to 2023 American College of Surgeons National Surgical Quality Improvement Program databases. Patients undergoing orthognathic surgery were included. Patients with missing data or undergoing concurrent temporomandibular joint or facial cosmetic procedures were excluded.
Predictor Variable:
The predictor was discharge pathway, categorized as either same day discharge from the hospital or inpatient admission.
Main Outcome Variable:
The primary outcome was hospital readmission within 30 days of surgery.
Covariates:
Covariates were categorized into demographic (age, sex), medical (hypertension, diabetes), and perioperative (type of surgery, operative time).
Analyses:
Descriptive and bivariate statistics were performed to evaluate the association between discharge pathway and readmission. Linear regression was utilized to analyze trends in discharge pathway over time.
Results:
The cohort was composed of 2,056 subjects with a mean age of 28.8 ± 10.8 years, and 1,035 were male (50.3%). Of these, 468 (22.8%) were discharged the same day and 1,588 (77.2%) were admitted. Readmission rates were 0.40% (n = 2) for same day discharge and 1.10% (n = 17) for inpatient admission (relative risk 0.4, 95% CI 0.09 to 1.72, P = .3). In bivariate analysis, no study covariates including discharge pathway were associated with readmission. The mean time between discharge and readmission for the same day discharge and inpatient admission groups were 7.5 ± 6.4 days and 12.2 ± 9.0 days, respectively (P = .4). The frequency of same day discharge increased during the study period from 10.7% in 2011 to 23.1% in 2023 (P = .03).
Conclusions And Relevance:
Same day discharge was not associated with an increased risk of 30-day readmission in appropriately selected patients.
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