Hospital costs and factors associated with days alive and at home after surgery (DAH(30) )

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 (DAH(30)). 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 DAH(30) and total hospital costs, and between DAH(30) 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 DAH(30) 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 DAH(30) and total hospital costs was moderate (Spearman ρ = –0.60; P < 0.001). Median DAH(30) declined with age, comorbidity score, ASA physical status score, and surgical severity and duration, and was also lower for women. Conclusions: DAH(30) 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. DAH(30) 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.