Patient and hospital characteristics for patients with and without delayed discharge after emergency surgery
| Variable | Group; no. (%) of patients* | Std. diff.† | ||
|---|---|---|---|---|
| Non-ALC n = 145 033 | ALC n = 35 445 | Total n = 180 478 | ||
| Patient characteristics | ||||
| Age, yr, median (IQR) | 71 (60–81) | 80 (71–86) | 73 (62–83) | 0.57 |
| Sex, female | 68 200 (47.0) | 21 081 (59.5) | 89 281 (49.5) | 0.25 |
| Comorbidity | ||||
| Atrial fibrillation | 14 054 (9.7) | 4921 (13.9) | 18 975 (10.5) | 0.13 |
| Asthma | 19 991 (13.8) | 5325 (15.0) | 25 316 (14.0) | 0.04 |
| Coronary artery disease | 35 213 (24.3) | 5461 (15.4) | 40 674 (22.5) | 0.22 |
| COPD | 39 013 (26.9) | 11 309 (31.9) | 50 322 (27.9) | 0.11 |
| Stroke | 5427 (3.7) | 2136 (6.0) | 7563 (4.2) | 0.11 |
| Diabetes mellitus | 49 836 (34.4) | 13 311 (37.6) | 63 147 (35.0) | 0.07 |
| Hypertension | 106 934 (73.7) | 28 869 (81.4) | 135 803 (75.2) | 0.19 |
| Chronic liver disease | 3237 (2.2) | 779 (2.2) | 4016 (2.2) | 0 |
| Myocardial infarction | 20 252 (14.0) | 2881 (8.1) | 23 133 (12.8) | 0.19 |
| Cancer | 14 697 (10.1) | 3278 (9.2) | 17 975 (10.0) | 0.03 |
| Renal disease | 9656 (6.7) | 2702 (7.6) | 12 358 (6.8) | 0.04 |
| Dementia | 7493 (5.2) | 3263 (9.2) | 10 756 (6.0) | 0.16 |
| Charlson comorbidity index ≥ 2 | 49 777 (34.3) | 13 197 (37.2) | 62 974 (34.9) | 0.06 |
| Rural residence | 18 055 (12.5) | 2210 (6.2) | 20 265 (11.2) | 0.21 |
| Median neighbourhood income‡ | ||||
| Quintile 1 (lowest) | 30 140 (20.9) | 8512 (24.1) | 38 652 (21.5) | 0.08 |
| Quintile 2 | 29 589 (20.5) | 7364 (20.9) | 36 953 (20.6) | 0.01 |
| Quintile 3 | 28 420 (19.7) | 6513 (18.5) | 34 933 (19.5) | 0.03 |
| Quintile 4 | 28 947 (20.1) | 6402 (18.2) | 35 349 (19.7) | 0.05 |
| Quintile 5 (highest) | 27 170 (18.8) | 6480 (18.4) | 33 650 (18.7) | 0.01 |
| Hospital and surgical characteristics | ||||
| Type of surgery | ||||
| AAA repair | 3018 (2.1) | 255 (0.7) | 3273 (1.8) | 0.12 |
| Hip fixation | 16 825 (11.6) | 7331 (20.7) | 24 156 (13.4) | 0.25 |
| Joint replacement | 31 064 (21.4) | 14 156 (39.9) | 45 220 (25.1) | 0.41 |
| Lower gastrointestinal | 27 927 (19.3) | 3363 (9.5) | 31 290 (17.3) | 0.28 |
| Transplant | 7590 (5.2) | 350 (1.0) | 7940 (4.4) | 0.25 |
| Cardiac | 32 164 (22.2) | 1269 (3.6) | 33 433 (18.5) | 0.58 |
| Neurosurgery | 11 838 (8.2) | 1976 (5.6) | 13 814 (7.7) | 0.10 |
| Peripheral arterial disease | 8085 (5.6) | 4135 (11.7) | 12 220 (6.8) | 0.22 |
| Spine | 6522 (4.5) | 2610 (7.4) | 9132 (5.1) | 0.12 |
| Trauma admission | 48 603 (33.5) | 21 745 (61.3) | 70 348 (39.0) | 0.58 |
| Duration of surgery, min, median (IQR) | 165 (102–253) | 118 (86–173) | 151 (98–241) | 0.46 |
| No. of hospital beds, median (IQR) | 317 (211–423) | 291 (209–380) | 310 (211–419) | 0.14 |
| Teaching hospital§ | 49 561 (43.9) | 13 529 (39.6) | 63 090 (42.9) | 0.09 |
| Surgical volume, median (IQR)¶ | 4842 (2750–9138) | 3904 (2481–7708) | 4242 (2605–9 138) | 0.23 |
| Perioperative care | ||||
| ICU admission ≤ 24 h after surgery§ | 20 401 (18.1) | 4998 (14.6) | 25 399 (17.3) | 0.09 |
| ICU admission > 24 h after surgery§ | 2456 (2.2) | 978 (2.9) | 3434 (2.3) | 0.21 |
| Intra-arterial line | 44 407 (30.6) | 8998 (25.4) | 53 405 (29.6) | 0.12 |
| Central venous line | 15 516 (10.7) | 2126 (6.0) | 17 642 (9.8) | 0.17 |
| Postoperative outcomes | ||||
| Total hospital stay, d, median (IQR) | 9 (6–15) | 20 (12–38) | 10 (7–18) | 1.06 |
| ALC stay, d, median (IQR) | 0 (0–0) | 6 (3–14) | 0 (0–0) | 12.5 |
| DAH30, d, median (IQR) | 21 (11–25) | 11 (0–20) | 20 (7–24) | 0.77 |
| DAH90, d, median (IQR) | 80 (62–84) | 66 (27–78) | 78 (54–84) | 0.68 |
| DAH180, d, median (IQR) | 169 (139–174) | 148 (70–167) | 166 (120–173) | 0.64 |
| Complication | 34 618 (23.9) | 10 272 (29.0) | 44 890 (24.9) | 0.22 |
| Discharge disposition | ||||
| Home with home care | 37 537 (25.9) | 5089 (14.4) | 42 626 (23.6) | 0.29 |
| Home independently | 55 435 (38.2) | 1438 (4.1) | 56 873 (31.5) | 0.92 |
| Long-term or complex continuing care | 37 145 (25.6) | 26 661 (75.2) | 63 806 (35.4) | 1.14 |
| Other** | 14 916 (10.3) | 2257 (6.4) | 17 173 (9.5) | 0.14 |
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), except for chronic liver disease (p = 0.7).
↵‡ Income data were missing for 941 patients: 767 in the non-ALC group and 174 in the ALC group.
↵§ For these variables, data were available for 147 045 patients: 112 869 in the non-ALC group and 34 176 in the ALC group.
↵¶ Over the entire study period.
↵** “Other” includes hospice, palliative care, interhospital transfer and left against medical advice.