Document Detail


Impact of length of stay after coronary bypass surgery on short-term readmission rate: an instrumental variable analysis.
MedLine Citation:
PMID:  23032357     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: : To determine the effect of postoperative length of stay (LOS) on 30-day readmission after coronary artery bypass surgery.
DATA SOURCES/STUDY SETTING: : We analyzed a final database consisting of Medicare claims of a cohort (N=157,070) of all fee-for-service beneficiaries undergoing bypass surgery during 2007-2008, the American Hospital Association annual survey file, and the rural urban commuting area file.
STUDY DESIGN: : We regressed the probability of 30-day readmission on postoperative LOS using (1) a (naive) logit model that controlled for observed patient and hospital covariates only; and (2) a residual inclusion instrumental variable (IV) logit model that further controlled for unobserved confounding. The IV was defined using a measure of the hospital's risk-adjusted LOS for patients admitted for gastrointestinal hemorrhage.
PRINCIPAL FINDINGS: : The naive logit model predicted that a 1-day reduction in median postoperative LOS (ie, from a median of 6-5 d) lowered the 30-day readmission rate by 2 percentage points. The IV model predicted that a 1-day reduction in median postoperative LOS increased 30-day readmission rate by 3 percentage points.
CONCLUSIONS: : The findings indicate that a reduction in postoperative LOS is associated with an increased risk for 30-day readmission among Medicare patients undergoing bypass surgery, after both observed and unobserved confounding effects are corrected.
Authors:
Yue Li; Xueya Cai; Dana B Mukamel; Peter Cram
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-02-20     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  45-51     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Coronary Artery Bypass / statistics & numerical data*
Hospitals / statistics & numerical data
Humans
Insurance Claim Review / statistics & numerical data
Length of Stay / statistics & numerical data*
Logistic Models
Medicare / statistics & numerical data
Patient Readmission / statistics & numerical data*
Quality of Health Care / statistics & numerical data
Risk Factors
Sex Factors
Time Factors
United States
Grant Support
ID/Acronym/Agency:
AR062133/AR/NIAMS NIH HHS; R01 AG033035/AG/NIA NIH HHS; R01 AG033202/AG/NIA NIH HHS; R01 HL085347/HL/NHLBI NIH HHS; R01AG033202/AG/NIA NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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