Expedited discharge and risk of readmission after ostomy construction

Background

Expedited discharge after surgery with construction of an ostomy may leave patients less prepared for home self-care, leading to increased hospital readmissions. We evaluated whether readmission rates were greater for patients with an expedited discharge (1–2 days) compared with nonexpedited discharge (3–5 days) after ostomy construction.

Methods

A retrospective analysis of a prospective database of patients undergoing ostomy construction was performed using the American College of Surgeons National Safety and Quality Improvement Project data between years 2019 and 2020. Inclusion criteria included age >18 years, discharge to home, and postoperative length of stay 1–5 days. Patients were grouped into either expedited or nonexpedited discharge by postoperative length of stay. The primary outcome was 30-day postoperative readmission. Analysis included multivariable logistic regression models and partial effects analysis.

Results

Of 13,628 patients included, 14.5% (n = 1,980) had an expedited discharge. Rates of 30-day readmission were 13.6% in the expedited group and 14.2% in the nonexpedited group (P = .51). Adjusting for patient and procedure factors, there was no significant difference in readmission rates between expedited and nonexpedited discharge groups (odds ratio, 1.08; 95% confidence interval, 0.94–1.25). In stratified analysis, there was no difference in readmission by discharge timing for any procedure type. The top 3 contributors to having an expedited discharge, as assessed by partial effects analysis, were procedure type, elective surgery, and pre-operative sepsis.

Conclusions

Early discharge within 1–2 days of ostomy construction was not associated with increased 30-day hospital readmissions. These findings support expedited discharges after ostomy construction in carefully selected, eligible patients.