Emergency Department Length of Stay and 72-Hour Returns in Uncomplicated Abdominal Pain.

OBJECTIVE: To evaluate whether a shorter emergency department (ED) length of stay (LOS) is associated with an increased risk of adverse outcomes in adults discharged with uncomplicated non-traumatic abdominal pain. PATIENTS AND METHODS: In this retrospective multilevel cohort study (January 1, 2021, through December 31, 2023), adult ED visits for non-traumatic abdominal pain were analyzed. A primary Uncomplicated Cohort (N=28,803) excluded complex comorbidities. The primary exposure was ED LOS quartiles (Q1: Shortest to Q4: Longest). The primary and secondary outcomes were 72-hour return visits and high-risk returns (requiring admission), respectively. Multilevel logistic regression adjusted for confounders, with sensitivity analyses in a general cohort (N=32,247) and a Triage Level 3 subgroup. RESULTS: Among uncomplicated visits, the shortest LOS quartile (Q1) exhibited significantly lower odds of 72-hour return visits compared with the longest quartile (Q4) (adjusted odds ratio [aOR], 0.63; 95% CI, 0.52-0.75). Similarly, Q1 demonstrated significantly lower odds of high-risk returns (aOR, 0.44; 95% CI, 0.31-0.61). This association persisted in the Triage Level 3 subgroup (aOR, 0.64; 95% CI, 0.52-0.79) and the general cohort (aOR, 0.48; 95% CI, 0.41-0.57). Physician-level variance was minimal (intraclass correlation coefficient <0.01), suggesting outcomes were largely driven by patient and system factors rather than individual provider practice. CONCLUSION: In this uncomplicated cohort, decreased ED LOS was associated with lower odds of adverse outcomes. This suggests expedited disposition does not correlate with a higher risk of short-term return visits or subsequent admissions. Rather than serving as a protective safety net, prolonged evaluation likely signals underlying diagnostic ambiguity or patient complexity.