Factors Associated With Delays in Discharge for Patients Undergoing Chronic Wound Reconstruction.

Abstract

Background: Delay in discharge following chronic wound reconstruction is a concern that adds to the national hospital bed shortage crisis. This study aims to identify and analyze the factors associated with delay in discharge after wound reconstruction.

Methods: A retrospective chart review of all patients who underwent chronic wound reconstruction by a plastic surgeon at a single tertiary academic hospital from January 2019 to December 2021 was performed using CPT codes. Patients admitted with other primary diagnoses or to the ICU were excluded. Demographic data as well as socioeconomic factors, insurance status, disposition, and other discharge needs were recorded and analyzed in relation to days delay in discharge. A univariate negative binomial count model was used for statistical analysis.

Results: A total of 131 encounters were included in the study with 61 encounters in delay group and 70 in no delay group. Delay group experienced mean discharge delay of 3.03 days. There were no significant differences in medical comorbidities between the 2 groups. Patients with commercial insurances had shorter mean delay (0.79 days) compared to that of patients with government-issued insurances (1.52-1.69 days). Those discharging to a facility like rehabilitation center, skilled nursing facility, or long-term acute care had about 3.5 days of delay compared to those going home. Other requirements such as IV antibiotics, home VAC, or durable medical equipment did not significantly affect discharge timing in discharge.

Conclusion: Delays in discharge after chronic wound reconstruction are common, and socioeconomic factors including insurance status and disposition were the 2 most significant predictors of delay.