National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy

Abstract

Background

Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases.

Methods

We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.

Results

SDD patients had lower comorbidity (33 ​% vs 21 ​%) and illness severity (79 ​% vs 63 ​%), more Medicare insurance (44 ​% vs 38 ​%), and more benign neoplasms (52 ​% vs 17 ​%). Most SDD patients underwent right colectomy (89 ​%). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p ​< ​0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged.

Conclusion

SDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.