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. 2013 Jan;51(1):45-51.
doi: 10.1097/MLR.0b013e318270bc13.

Impact of length of stay after coronary bypass surgery on short-term readmission rate: an instrumental variable analysis

Yue Li  1 , Xueya Cai, Dana B Mukamel, Peter Cram
Affiliations

Impact of length of stay after coronary bypass surgery on short-term readmission rate: an instrumental variable analysis

Yue Li et al. Med Care. 2013 Jan.

Abstract

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.

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Figures

Figure 1
Figure 1
Distribution of postoperative length of stay among Medicare patients undergoing coronary bypass surgery.
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