Impact of Length of Stay After Coronary Bypass Surgery on Short-term Readmission Rate

OBJECTIVE: : To determine the effect of postoperative length of stay (LOS) on 30-day readmission after coronary artery bypass surgery. DATA SOURCES/STUDY SETTING: : We analyzed a final database consisting of Medicare claims of a cohort (N=157,070) of all fee-for-service beneficiaries undergoing bypass surgery during 2007-2008, the American Hospital Association annual survey file, and the rural urban commuting area file. STUDY DESIGN: : We regressed the probability of 30-day readmission on postoperative LOS using (1) a (naive) logit model that controlled for observed patient and hospital covariates only; and (2) a residual inclusion instrumental variable (IV) logit model that further controlled for unobserved confounding. The IV was defined using a measure of the hospital's risk-adjusted LOS for patients admitted for gastrointestinal hemorrhage. PRINCIPAL FINDINGS: : The naive logit model predicted that a 1-day reduction in median postoperative LOS (ie, from a median of 6-5 d) lowered the 30-day readmission rate by 2 percentage points. The IV model predicted that a 1-day reduction in median postoperative LOS increased 30-day readmission rate by 3 percentage points. CONCLUSIONS: : The findings indicate that a reduction in postoperative LOS is associated with an increased risk for 30-day readmission among Medicare patients undergoing bypass surgery, after both observed and unobserved confounding effects are corrected

Artery · Bypass surgery · Cardiology · Coronary artery bypass surgery · Physics · Term (time) · Cardiac and Coronary Surgery Techniques · Heart Failure Treatment and Management · Medicine · Sepsis Diagnosis and Treatment · Surgery

• Rehospitalizations among Patients in the Medicare Fee-for-Service Program

  Stephen F Jencks, Malcolm V Williams et al.•New England Journal of Medicine•2009

  Incluir item

• Heart Disease and Stroke Statistics—2011 Update

  Véronique L Roger, Alan S Go et al.•Circulation•2011

  Incluir item

• Two-stage residual inclusion estimation

  Open Access•Joseph V Terza, Anirban Basu et al.•Journal of Health Economics•2008

  Incluir item

• Identification of Causal Effects Using Instrumental Variables

  Joshua D Angrist, Guido W Imbens et al.•Journal of the American…•1996

  Incluir item

• Instrumental Variables Regression with Weak Instruments

  Douglas O Staiger, Douglas Staiger et al.•Econometrica•1997

  Incluir item

• Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents

  Thomas M Wickizer, Daniel Lessler et al.•American Journal of Public Health•1999

  Incluir item

• Comparison of Coding of Heart Failure and Comorbidities in Administrative and Clinical Data for Use in Outcomes Research

  Douglas S Lee, Linda Donovan et al.•Medical Care•2005

  Incluir item

• Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data

  Hude Quan, Vijaya Sundararajan et al.•Medical Care•2005

  Incluir item

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Incluir item

• Differences in Length of Stay in Veterans Health Administration and Other United States Hospitals

  Gary E Rosenthal, Peter J Kaboli et al.•Medical Care•2003

  Incluir item