The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis

Decreasing hospital length-of-stay (LOS) may be an effective strategy to reduce costs while also improving outcomes through earlier discharge to the non-hospital setting. The objective of the current study was to define the impact of discharge timing on readmission, mortality, and charges following hepatopancreatobiliary (HPB) surgery. The Nationwide Readmissions Database (NRD) was used to identify patients undergoing HPB procedures between 2010 and 2014. Length of stay (LOS) was categorized as early discharge (4–5 days), routine discharge (6–9 days), and late discharge (10–14 days). Univariable and multivariable analyses were utilized to identify factors associated with 90-day readmission. A total of 28,114 patients underwent HPB procedures. Overall median LOS was 7 days (IQR 5–11); 10,438 (37.1%) patients had an early discharge, while 13,665 (48.6%) and 4011 (14.3%) patients had a routine or late discharge. The probability of early discharge increased over time (referent 2010: 2011–4% (OR 1.04, 95% CI 0.96–1.15) vs. 2012–10% (OR 1.10, 95% CI 1.01–1.20) vs. 2013–21% (OR 1.21, 95% CI 1.11–1.32) vs. 2014–32% (OR 1.32, 95% CI 1.21–1.44)) (p