TY - JOUR
T1 - Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement
AU - Voeten, Daan M.
AU - van der Werf, Leonie R.
AU - van Sandick, Johanna W.
AU - van Hillegersberg, Richard
AU - van Berge Henegouwen, Mark I.
AU - on behalf of the Dutch Upper Gastrointestinal Cancer Audit Group
N1 - Funding Information:
The authors would like to thank all surgeons, registrars, physician assistants and administrative nurses for data registration in the DUCA database, as well as the Dutch Upper Gastrointestinal Cancer Audit group for scientific input.
Publisher Copyright:
© 2020, The Author(s).
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - Esophageal carcinoma
KW - Hospital variation
KW - Hospital volume
KW - Length of hospital stay
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=85094159382&partnerID=8YFLogxK
U2 - 10.1007/s00464-020-08103-4
DO - 10.1007/s00464-020-08103-4
M3 - Article
C2 - 33104919
AN - SCOPUS:85094159382
VL - 35
SP - 6344
EP - 6357
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
IS - 11
ER -