Early discharge after lung surgery benefits patients without increasing the risk of readmission


When hospitals implement programs to optimize patient recovery after surgery, healthcare costs go down and patients experience better outcomes. One of the main benefits of the programs – known as Enhanced Recovery Pathways – includes shorter hospital stays. But thoracic surgeons are often reluctant to release patients in an accelerated time frame for fear that an early discharge will harm their patients and lead to early readmissions.

Now, a team of researchers from Jefferson Health have examined the hypothesis and shown that early discharge does not increase the risk of patients re-admitted after minimally invasive lung surgery. The result indicates that early discharge is a safe practice for institutions with well-established improved recovery pathways.

IMPACT

Enhanced Recovery Pathways are a set of protocols that surgical teams use before, during, and after surgery to provide the best possible patient care. As part of Jefferson’s well-defined ERP, physicians educate patients who have had lung surgery on the benefits of quitting smoking before the procedure.

During the operation, surgeons use minimally invasive techniques and closely monitor patients’ fluids. After the procedure, nurses specially trained to care for thoracic surgery patients closely monitor any changes in their condition.

Doctors also minimize the use of opioids and other narcotics, while encouraging patients to eat regularly and recover as soon as possible. The combination of interventions promotes patient recovery.

The team analyzed the readmission rates of nearly 300 patients who underwent lung resection in Jefferson between January 2010 and July 2017. On average, patients remained in the hospital for three to five days after surgery, but for Over the duration of the study, about half of the patients went home within one or two days.

Investigators matched the “middle” and “early” groups based on symptoms, disease stage, and other factors to ensure an apples-to-apples comparison. Yet Evans and his team found that patients who were discharged earlier, one to two days after surgery, had lower hospital readmission rates.

The Centers for Medicare and Medicaid Services are imposing financial penalties on hospitals that underperform on the 30-day readmission metric, so the results could have positive 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 for an average length of time suffered complications, compared with just 7 percent of patients who were discharged prematurely.

Overall, the risk of readmission was 2.3 times higher for patients who remained in hospital for three to five days after surgery than for patients with early discharge. The results show that for facilities with well-defined improved recovery pathways, early discharge does not increase the risk of readmission for patients with thoracic surgery, 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 patient readmissions to the neurocritical care unit, according to last year’s results.

Neurology is not the only clinical area affected by reimbursements related to readmissions. Cardiology patients have better survival rates in hospitals at the top of the US News and World Report rankings, but the risk of readmission is more or less the same – and with 30-day readmissions tied to reimbursement, that could pose a risk. problem for providers anytime on the spectrum.

Twitter: @JELagasse

Email the author: [email protected]



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