Emergency Department Length of Stay and 72-Hour Returns in Uncomplicated Abdominal Pain

To evaluate whether a shorter emergency department (ED) length of stay (LOS) is associated with an increased risk of adverse outcomes in adults discharged with uncomplicated non-traumatic abdominal pain.

In this retrospective multilevel cohort study (January 1, 2021, through December 31, 2023), adult ED visits for non-traumatic abdominal pain were analyzed. A primary Uncomplicated Cohort (N=28,803) excluded complex comorbidities. The primary exposure was ED LOS quartiles (Q1: Shortest to Q4: Longest). The primary and secondary outcomes were 72-hour return visits and high-risk returns (requiring admission), respectively. Multilevel logistic regression adjusted for confounders, with sensitivity analyses in a general cohort (N=32,247) and a Triage Level 3 subgroup.

Among uncomplicated visits, the shortest LOS quartile (Q1) exhibited significantly lower odds of 72-hour return visits compared with the longest quartile (Q4) (adjusted odds ratio [aOR], 0.63; 95% CI, 0.52-0.75). Similarly, Q1 demonstrated significantly lower odds of high-risk returns (aOR, 0.44; 95% CI, 0.31-0.61). This association persisted in the Triage Level 3 subgroup (aOR, 0.64; 95% CI, 0.52-0.79) and the general cohort (aOR, 0.48; 95% CI, 0.41-0.57). Physician-level variance was minimal (intraclass correlation coefficient <0.01), suggesting outcomes were largely driven by patient and system factors rather than individual provider practice.

In this uncomplicated cohort, decreased ED LOS was associated with lower odds of adverse outcomes. This suggests expedited disposition does not correlate with a higher risk of short-term return visits or subsequent admissions. Rather than serving as a protective safety net, prolonged evaluation likely signals underlying diagnostic ambiguity or patient complexity.