Patient and hospital characteristics for patients with and without delayed discharge after elective surgery
| Variable | Group; no. (%) of patients* | Std. diff.† | ||
|---|---|---|---|---|
| Non-ALC n = 577 505 | ALC n = 18 277 | Total n = 595 782 | ||
| Patient characteristics | ||||
| Age, yr, median (IQR) | 67 (59–75) | 75 (67–81) | 67 (60–75) | 0.62 |
| Sex, female | 295 358 (51.1) | 10 793 (59.1) | 306 151 (51.4) | 0.16 |
| Comorbidity | ||||
| Atrial fibrillation | 22 180 (3.8) | 1663 (9.1) | 23 843 (4.0) | 0.21 |
| Asthma | 89 085 (15.4) | 3161 (17.3) | 92 246 (15.5) | 0.05 |
| Coronary artery disease | 47 685 (8.3) | 2514 (13.8) | 50 199 (8.4) | 0.18 |
| COPD | 124 741 (21.6) | 5230 (28.6) | 129 971 (21.8) | 0.16 |
| Stroke | 7268 (1.3) | 613 (3.4) | 7881 (1.3) | 0.14 |
| Diabetes mellitus | 156 854 (27.2) | 6774 (37.1) | 163 628 (27.5) | 0.21 |
| Hypertension | 401 546 (69.5) | 14 934 (81.7) | 416 480 (69.9) | 0.29 |
| Chronic liver disease | 2383 (0.4) | 142 (0.8) | 2525 (0.4) | 0.05 |
| Myocardial infarction | 18 300 (3.2) | 1026 (5.6) | 19 326 (3.2) | 0.12 |
| Cancer | 40 034 (6.9) | 1449 (7.9) | 41 483 (7.0) | 0.04 |
| Renal disease | 7335 (1.3) | 729 (4.0) | 8064 (1.4) | 0.17 |
| Dementia | 2203 (0.4) | 460 (2.5) | 2663 (0.4) | 0.18 |
| Charlson comorbidity index ≥ 2 | 78 893 (13.7) | 4675 (25.6) | 83 568 (14.0) | 0.30 |
| Rural residence | 93 995 (16.3) | 1774 (9.7) | 95 769 (16.1) | 0.20 |
| Median neighbourhood income‡ | ||||
| Quintile 1 (lowest) | 97 292 (16.9) | 3938 (21.6) | 101 230 (17.1) | 0.12 |
| Quintile 2 | 113 137 (19.7) | 3930 (21.6) | 117 067 (19.7) | 0.05 |
| Quintile 3 | 115 044 (20.0) | 3590 (19.7) | 118 634 (20.0) | 0.01 |
| Quintile 4 | 122 834 (21.3) | 3400 (18.7) | 126 234 (21.3) | 0.07 |
| Quintile 5 (highest) | 127 049 (22.1) | 3352 (18.4) | 130 401 (22.0) | 0.09 |
| Hospital and surgical characteristics | ||||
| Type of surgery | ||||
| AAA repair | 15 704 (2.7) | 345 (1.9) | 16 049 (2.7) | 0.06 |
| Joint replacement | 346 035 (59.9) | 10 546 (57.7) | 356 581 (59.9) | 0.05 |
| Lower gastrointestinal | 69 472 (12.0) | 1487 (8.1) | 70 959 (11.9) | 0.13 |
| Nephrectomy | 16 900 (2.9) | 151 (0.8) | 17 051 (2.9) | 0.16 |
| Cardiac | 51 892 (9.0) | 1687 (9.2) | 53 579 (9.0) | 0.01 |
| Lung | 24 847 (4.3) | 218 (1.2) | 25 065 (4.2) | 0.19 |
| Neurosurgery | 7155 (1.2) | 488 (2.7) | 7643 (1.3) | 0.10 |
| Peripheral arterial disease | 12 655 (2.2) | 1303 (7.1) | 13 958 (2.3) | 0.24 |
| Spine | 32 845 (5.7) | 2052 (11.2) | 34 897 (5.9) | 0.20 |
| Duration of surgery, min, median (IQR) | 163 (120–215) | 168 (129–217) | 163 (120–215) | 0.10 |
| No. of hospital beds, median (IQR) | 373 (291–513) | 423 (298–527) | 373 (291–513) | 0.24 |
| Teaching hospital§ | 195 473 (37.2) | 7431 (44.8) | 202 904 (37.4) | 0.16 |
| Surgical volume, median (IQR)¶ | 12 663 (7519–17 719) | 13 472 (7859–20 023) | 12 663 (7535–17 719) | 0.10 |
| Perioperative care | ||||
| ICU admission ≤ 24 h after surgery§ | 54 915 (10.4) | 3032 (18.3) | 57 947 (10.7) | 0.22 |
| ICU admission > 24 h after surgery§ | 4775 (0.9) | 690 (4.2) | 5465 (1.0) | 0.21 |
| Intra-arterial line | 131 222 (22.7) | 5350 (29.3) | 136 572 (22.9) | 0.15 |
| Central venous line | 21 874 (3.8) | 1028 (5.6) | 22 902 (3.8) | 0.09 |
| Postoperative outcomes | ||||
| Total hospital stay, d, median (IQR) | 4 (3–6) | 10 (7–17) | 4 (3–6) | 1.57 |
| ALC stay, d, median (IQR) | 0 (0–0) | 3 (2–6) | 0 (0–0) | 80.72 |
| DAH30, d, median (IQR) | 26 (24–27) | 20 (11–23) | 26 (24–27) | 1.46 |
| DAH90, d, median (IQR) | 86 (83–87) | 79 (66–83) | 86 (83–87) | 1.41 |
| DAH180, d, median (IQR) | 175 (173–177) | 167 (151–173) | 175 (172–177) | 1.34 |
| Complication | 79 951 (13.8) | 6274 (34.3) | 86 225 (14.5) | 0.49 |
| Discharge disposition | ||||
| Home with home care | 214 490 (37.1) | 4189 (22.9) | 218 679 (36.7) | 0.31 |
| Home independently | 293 601 (50.8) | 1433 (7.8) | 295 034 (49.5) | 1.07 |
| Long-term or complex continuing care | 62 146 (10.8) | 12 156 (66.5) | 74 302 (12.5) | 1.4U |
| Other** | 7268 (1.3) | 499 (2.7) | 7767 (1.3) | 0.11 |
Note: AAA = abdominal aortic aneurysm, ALC = alternate level of care, COPD = chronic obstructive pulmonary disease, DAH = days alive and out of hospital, GI = gastrointestinal, ICU = intensive care unit, IQR = interquartile range, PAD = peripheral arterial disease, std. diff. = standardized difference.
↵* Except where indicated otherwise.
↵† All comparisons between ALC and non-ALC patients were significant (p < 0.001).
↵‡ Income data were missing for 2216 patients: 2149 in the non-ALC group and 67 in the ALC group.
↵§ For these variables, data were available for 542 203 patients: 525 613 in the non-ALC group and 16 590 in the ALC group.
↵¶ Over the entire study period.
↵** “Other” includes hospice, palliative care, interhospital transfer and left against medical advice.