Post-Discharge Surgical Complication Risk Linked to Shorter Lengths of Hospital Stay

Complications involving infections and heart problems have seen the highest increase as hospital stay lengths decreased over the last 20 years.

If a patients is discharged from the hospital earlier, they appear to face an increased risk of suffering post-surgical complications, according to the findings of a new study.

Researchers with the Northwestern University Feinberg School of Medicine report that a growing trend of decreasing the length of hospital stays after surgery is linked to increasing rates of problems experienced by patients after discharged.

The study focused on length of stay and post-discharge complications for surgical patients, using data from the American College of Surgeons National Surgical Quality Improvement Program database. A complication was considered post-discharge if it occurred within the first 30 days after surgery.

Researchers compared data from 2014 and 2019, for patients who underwent any one of 11 surgical procedures of the colon and rectum; esophagus; hepatopancreatobiliary system involving the liver, pancreas, gallbladder and bile ducts; or gynecologic or urologic systems. The findings from the study were presented at the American College of Surgeons virtual Clinical Congress 2021, but are considered preliminary until published in a peer reviewed journal.

Over the past 20 years, hospitals have shortened patient hospital stays for a variety of reasons; including emphasis on outpatient treatment, bed shortages, cost-cutting measures, and payers’ requirements. During that time, the average length of stay after surgery has dropped by one-third. In 2014, the average length was three days and in 2019 the average dropped to two days.

While the overall rate of postoperative complications declined 1% over the five-year study, the proportion of post-discharge complications increased from 44.6% in 2014 to 56.5% by 2019.

The researchers detected a 12% increase in post-discharge complications across several common surgical specialties for more than 538,000 American patients. The highest increase in serious complications linked to earlier discharges occurred among cases of infections and heart problems.

Surgical site infections and infections like pneumonia, urinary tract infection, and sepsis, a serious bloodstream infection, all increased. Other complications that also increased were heart attacks, cardiac arrests, strokes and venous thromboembolism.

The researchers found that higher body mass index, worse health status going into the surgery, more severe wounds, and longer operation times were also factors which increased the risk of complications.

Currently, doctors use a wait-and-see approach after a patient is discharged following their first postoperative visit. Doctors wait for patients to report concerning signs and symptoms or to visit the emergency room with problems.

Despite this approach, many of the complications patients experience after surgery are preventable and early detection can help reduce serious consequences, such as sepsis and even death.

However, some patients and caregivers do not recognize early symptoms of complications, which can make the complications worse in the long run. Early intervention can help prevent some complications or reduce the severity of others.

The researchers called for doctors to focus on patient education and family education before the operation and before discharge from the hospital. Information regarding signs of complications and infection should be communicated to help patients and caregivers identify signs and symptoms of potential postsurgical complications.