Early discharge after lung surgery benefits patients without raising readmission risk

When hospitals implement programs to optimize patients' recovery from surgery, healthcare costs fall and patients show improved outcomes. One major benefit of the programs -- known as enhanced recovery pathways -- include shorter hospital stays. But thoracic surgeons are often reluctant to discharge patients on an accelerated time frame for fear early discharge might harm their patients and lead to early readmissions.

Now a team of researchers at Jefferson Health has examined the assumption and shown that early discharge does not increase readmission risk for patients after minimally invasive lung surgery. The finding indicates that early discharge is a safe practice for institutions with well-established enhanced recovery pathways.

IMPACT

Enhanced recovery pathways are a set of protocols surgical teams use before, during and after surgery to deliver the best possible care to patients. Within Jefferson's well-defined ERP, physicians educate lung surgery patients on the benefits of smoking cessation before the procedure.

During the operation, surgeons use minimally invasive techniques and closely monitor patients' fluids. Following the procedure, nurses specifically trained to care for thoracic surgery patients keep close watch on any changes to their condition.

Physicians also minimize the use of opioids and other narcotic drugs, while encouraging patients to eat regular food and get back on their feet as soon as they are able. The combination of interventions boosts patients' recovery.

The team analyzed readmission rates for nearly 300 patients who had undergone lung resection surgery at Jefferson between January 2010 and July 2017. On average, patients stayed in the hospital for three to five days after surgery, yet during the study time about half of patients went home in one or two days.

The investigators matched the "average" and "early" groups by symptoms, stage of disease and other factors to ensure an apples-to-apples comparison. Yet Evans and team found that patients who were discharged sooner, one to two days post-surgery, had lower rates of hospital readmission.

The Centers for Medicare and Medicaid Services levies financial penalties against hospitals who underperform on the 30-day readmission metric, so the findings could have positive bottom-line implications for hospitals.

WHAT ELSE YOU SHOULD KNOW   

Longer hospital stays were also associated with higher complication rates. Thirty percent of patients who stayed in the hospital an average amount of time suffered complications, compared to only 7 percent of patients that were discharged early.

Overall, readmission risk was 2.3 times greater for patients who stayed in the hospital for three to five days after surgery than early-discharge patients. The findings show that for institutions with well-defined enhanced recovery pathways, early discharge does not increase readmission risk for thoracic surgery patients, and may in fact reduce readmissions and improve patient outcomes.

THE TREND

Scoring models used to predict 30-day readmission risk in the general hospital population may not accurately predict readmissions for patients in the neurocritical care unit, findings showed last year.

Neurology isn't the only clinical area affected by reimbursements tied to readmissions. Cardiology patients have better survival rates at hospitals atop the U.S. News and World Report rankings, but the risk of readmission is more or less the same -- and with 30-day readmissions tied to reimbursement, this could pose an issue for providers at all points on the spectrum.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com