Hospital costs and factors associated with days alive and at home after surgery (DAH₃₀)

Objective: To assess the relationships of patient and surgical factors and hospital costs with the number of days alive and at home during the 30 days following surgery (DAH₃₀). Design: Retrospective cohort study; analysis of Medibank Private health insurance hospital claims data, Australia, 1 January 2016 – 31 December 2017. Setting, participants: Admissions of adults (18 years or older) to hospitals for elective or emergency inpatient surgery with anaesthesia covered by private health insurance, Australia, 1 January 2016 – 31 December 2017. Main outcome measures: Associations between DAH₃₀ and total hospital costs, and between DAH₃₀ and surgery risk factors. Results: Complete data were available for 126 788 of 181 281 eligible patients (69.9%); their median age was 62 years (IQR, 47–73 years), 72 872 were women (57%), and 115 117 had undergone elective surgery (91%). The median DAH₃₀ was 27.1 days (IQR, 24.2–28.8 days), the median hospital cost per patient was $10 358 (IQR, $6624–20 174). The association between DAH₃₀ and total hospital costs was moderate (Spearman ρ = –0.60; P < 0.001). Median DAH₃₀ declined with age, comorbidity score, ASA physical status score, and surgical severity and duration, and was also lower for women. Conclusions: DAH₃₀ is a validated, patient-centred outcome measure of post-surgical outcomes; higher values reflect shorter hospital stays and fewer serious complications, re-admissions, and deaths. DAH₃₀ can be used to benchmark quality of surgical care and to monitor quality improvement programs for reducing the costs of surgical and other peri-operative care.