Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement
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and Other Interventional Techniques
2020 EAES ORAL
Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement Daan M. Voeten1,2,5 · Leonie R. van der Werf1 · Johanna W. van Sandick3 · Richard van Hillegersberg4 · Mark I. van Berge Henegouwen1,6 · on behalf of the Dutch Upper Gastrointestinal Cancer Audit Group Received: 27 May 2020 / Accepted: 16 October 2020 © The Author(s) 2020
Abstract Background Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into ‘short admissions’ and ‘long admissions’. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. Results A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of ‘short admissions’ per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher ‘short admission’ rates and 4 hospitals had significantly lower ‘short admission’ rates. Overall, 6.2% [hospital variation (0.0–13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusions Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs. Keywords Esophageal carcinoma · Length of hospital stay · Readmission · Hospital volume · Hospital variation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08103-4) contains supplementary material, which is available to authorized users. * Daan M. Voeten [email protected]
4
Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
* Mark I. van Berge Henegouwen [email protected]
5
Department of Surger
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