• Léa Pascal, Stéphanie Polazzi, Vincent Piriou, Eddy Cotte, Julien Wegrzyn, Matthew J Carty, François Chollet, Stéphane Sanchez, Jean-Christophe Lifante, and Antoine Duclos.
• Health Data Center, Public Health Department, Lyon University Hospital, Lyon, France.
• Ann. Surg. 2020 Jul 1; 272 (1): 105-112.

ObjectiveThe aim of the study was to investigate whether patients who undergo surgery in hospitals experiencing significant length of stay (LOS) reductions over time are exposed to a higher risk of severe adverse events in the postoperative period.Summary Background DataSurgical care innovation has encouraged hospitals to shorten LOS under financial pressures with uncertain impact on patient outcomes.MethodsWe selected all patients who underwent elective colectomy or urgent hip fracture repair in French hospitals between 2013 and 2016. For each procedure, hospitals were categorized into 3 groups according to variations in their median LOS as follows: major decrease, moderate decrease, and no decrease. These groups were matched using propensity scores based on patients' and hospitals' potential confounders. Potentially avoidable readmission for severe adverse events and death at 6 months were compared between groups using Cox regressions.ResultsWe considered 98,713 patients in 540 hospitals for colectomy and 206,812 patients in 414 hospitals for hip fracture repair before matching. After colectomy, patient outcomes were not negatively impacted when hospitals reduced their LOS [hazard ratio (95% confidence interval): 0.93 (0.78-1.10)]. After hip fracture repair, patients in hospitals with major decreases in LOS had a higher risk of severe adverse events [1.22 (1.11-1.34)] and death [1.17 (1.04-1.32)].ConclusionsPatients who underwent surgical procedures in hospitals experiencing major decreases in LOS were demonstrated worse postoperative outcomes after urgent hip fracture repair and not after elective colectomy. Development of care bundles to enhance recovery after emergency surgeries may allow better control of LOS reduction and patient outcomes.

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