A longer hospital length of stay (>4.3 days) was associated with increased risks of one readmission (OR 2.32; 95% CI 1.86-2.88) and death over a two-year period (HR 2.25; 95% CI 2.05-2.47).
Cohort (n=32,270)
No
Is a shorter hospital length of stay associated with increased risk of readmissions and post-discharge mortality?
Shorter hospital length of stay is associated with favorable post-discharge outcomes, including lower early readmission and mortality rates, challenging concerns about premature discharge.
Odds Ratio: 2.32 (95% CI 1.86–2.88)
BACKGROUND: There exist wide variations in healthcare quality within the National Health Service (NHS). A shorter hospital length of stay (LOS) has been implicated as premature discharge, that may in turn lead to adverse consequences. We tested the hypothesis that a short LOS might be associated with increased risk of readmissions within 28 days of hospital discharge and also post-discharge mortality. METHODS: We conducted a single-centred study of 32 270 (46.1% men) consecutive alive-discharge episodes (mean age = 64.0 years, standard deviation = 20.5, range = 18-107 years), collected between 01/04/2017 and 31/03/2019. Associations of LOS tertiles (middle tertile as a reference) with readmissions and mortality were assessed using observed/expected ratios, and logistic and Cox regressions to estimate odds (OR) and hazard ratios (HR) (adjusted for age, sex, patients' severity of underlying health status and index admissions), with 95% confidence intervals (CIs). RESULTS: The observed numbers of readmissions within 28 days of hospital discharge or post-discharge mortality were lower than expected (observed: expected ratio 1) in patients in the top tertile (>4.3 days), amongst all ages. Patients in the top tertile of LOS had increased risks for one readmission: OR = 2.32 (95% CI = 1.86-2.88) or ≥2 readmissions: OR = 6.17 (95% CI = 5.11-7.45), death within 30 days: OR = 2.87 (95% CI = 2.34-3.51), and within six months of discharge: OR = 2.52 (95% CI = 2.23-2.85), and death over a two-year period: HR = 2.25 (95% CI = 2.05-2.47). The LOS explained 7.4% and 15.9% of the total variance (r2) in one readmission and ≥2 readmissions, and 9.1% and 10.0% of the total variance in mortality with 30 days and within six months of hospital discharge, respectively. Within the bottom, middle and top tertiles of the initial LOS, the median duration from hospital discharge to death progressively shortened from 136, 126 to 80 days, whilst LOS during readmission lengthened from 0.4, 0.9 to 2.8 days, respectively. CONCLUSION: Short LOS in hospital was associated with favourable post-discharge outcomes such as early readmission and mortality, and with a delay in time interval from discharge to death and shorter LOS in hospital during readmission. These findings indicate that timely discharge from our hospital meets the aims of the NHS-generated national improvement programme, Getting It Right First Time.
Han et al. (Thu,) conducted a cohort in Hospital admission (n=32,270). Top tertile of hospital length of stay (>4.3 days) vs. Middle tertile of hospital length of stay (1.2-4.3 days) was evaluated on One readmission (OR 2.32, 95% CI 1.86-2.88). A longer hospital length of stay (>4.3 days) was associated with increased risks of one readmission (OR 2.32; 95% CI 1.86-2.88) and death over a two-year period (HR 2.25; 95% CI 2.05-2.47).