Incidence and Factors Associated With Hospital Readmission After Pulmonary Lobectomy

Stiles, Brendon M.; Poon, Andrea; Giambrone, Gregory P.; Gaber-Baylis, Licia K.; Wu, Xian; Lee, Paul C.; Port, Jeffrey L.; Paul, Subroto; Bhat, Akshay U.; Zabih, Ramin; Altorki, Nasser K.; Fleischut, Peter

doi:10.1016/j.athoracsur.2015.10.001

Cited by 27 publications

(45 citation statements)

References 17 publications

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“…Finally, we did not collect information on the specific reasons why some patients received supportive care only for their recurrence. Functional decline and decreased quality of life after lung cancer surgery may have limited treatment options for some patients [46–48] while others may have refused cancer-directed therapy. Functional status and patient treatment preferences are important areas for future research on patterns of care for recurrent lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study

et al. 2016

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Objective-Older patients with non-small cell lung cancer (NSCLC) are less likely to receive guideline-recommended treatment at diagnosis, independent of comorbidity. However, national data on treatment of postoperative recurrence are limited. We evaluated the associations between age, comorbidity, and other patient factors and treatment of postoperative NSCLC recurrence in a national cohort.Materials and Methods-We randomly selected 9,001 patients with surgically resected stage I-III NSCLC in 2006-2007 from the National Cancer Data Base. Patients were followed for 5 years or until first NSCLC recurrence, new primary cancer, or death, whichever came first. Perioperative comorbidities, first recurrence, treatment of recurrence, and survival were abstracted from medical records and merged with existing registry data. Factors associated with active treatment (chemotherapy, radiation, and/or surgery) versus supportive care only were analyzed using multivariable logistic regression.Results-Median age at initial diagnosis was 67; 69.7% had ≥1 comorbidity. At 5-year followup, 12.3% developed locoregional and 21.5% developed distant recurrence. Among patients with locoregional recurrence, 79.5% received active treatment. Older patients (OR 0.49 for age ≥75 compared with <55; 95% CI 0.27-0.88) and those with substance abuse (OR 0.43; 95% CI 0.23-0.81) were less likely to receive active treatment. Women (OR 0.62; 95% CI 0.43-0.89) and patients with symptomatic recurrence (OR 0.69; 95% CI 0.47-0.99) were also less likely to receive active treatment. Among those with distant recurrence, 77.3% received active treatment. Older patients (OR 0.42 for age ≥75 compared with <55; 95% CI 0.26-0.68) and those with any documented comorbidities (OR 0.59; 95% CI 0.38-0.89) were less likely to receive active treatment.Conclusion-Older patients independent of comorbidity, patients with substance abuse, and women were less likely to receive active treatment for postoperative NSCLC recurrence. Studies to further characterize these disparities in treatment of NSCLC recurrence are needed to identify barriers to treatment.

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Section: Discussionmentioning

confidence: 99%

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study

et al. 2016

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“…6,9,10,13 On the other hand, similar to previously reported series, our results confirm that male gender, pre-existing comorbidity, lack of private insurance and geographic area of patient residence remain important preoperative characteristics associated with increased risk of readmission. 13,18 The current series is the first within the literature to report that lower income level and surgery at a non-academic/research facility are additional significant preoperative factors associated with readmission.…”

Section: Commentmentioning

confidence: 94%

“…In 2016, a study analyzing California, Florida and New York state inpatient databases identified that male gender, government insurance, and COPD significantly increase the risk of readmission following lobectomy. 18 …”

Section: Commentmentioning

confidence: 99%

Socioeconomic Factors Are Associated With Readmission After Lobectomy for Early Stage Lung Cancer

Medbery

Gillespie

Liu

et al. 2016

The Annals of Thoracic Surgery

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Background Data surrounding risk factors for readmissions following surgical resection for lung cancer are limited and largely focus on postoperative outcomes including complications and hospital length of stay. The current study aims to identify preoperative risk factors for postoperative readmission in early stage lung cancer patients. Methods The National Cancer Data Base was queried for all early stage lung cancer patients with clinical stage ≤T2N0M0 who underwent lobectomy in 2010–2011. Patients with unplanned readmission within 30 days of hospital discharge were identified. Univariate analysis was utilized to identify pre-operative differences between readmitted and non-readmitted cohorts; multivariable logistic regression was used to identify risk factors resulting in readmission. Results A total of 840/19,711 (4.3%) patients were readmitted postoperatively. Male patients were more likely to be readmitted vs. females (4.9 vs. 3.8%, p<0.001), as were those who received surgery at a non-academic vs. an academic facility (4.6 vs. 3.6%; p=0.001) and had underlying medical comorbidities (Charlson/Deyo Score 1+ vs. 0; 4.8 vs. 3.7%; p<0.001). Readmitted patients had a longer median hospital LOS; (6 vs. 5 days; p<0.001) and were more likely to have a minimally invasive approach (5.1% VATS vs. 3.9% open; p<0.001). In addition to these aforementioned variables, multivariable logistic regression analysis identified that median household income level, insurance status (government vs. private), and geographic residence (metro vs. urban vs. rural) had significant influence on readmission. Conclusions Socioeconomic factors identified significantly influence hospital readmission and should be considered during preoperative and postoperative discharge planning for patients with early stage lung cancer.

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“…Prior review of the ACS NSQIP database revealed an overall 30-day readmission rate for thoracic operations of 11.1% [11]. Although prior studies have outlined postoperative characteristics, including readmission, after open and thoracoscopic resections, they have not examined related, unplanned readmissions specifically [12]. Our study represents the largest multiple institutional analysis of related, unplanned readmissions after thoracoscopic versus open anatomic lung resection for primary lung cancer.…”

Section: Commentmentioning

confidence: 96%

National Analysis of Unplanned Readmissions After Thoracoscopic Versus Open Lung Cancer Resection

Bhagat

Bronsert

Ward

et al. 2017

The Annals of Thoracic Surgery

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Open anatomic lung resections for primary lung cancer had nearly twice the complication rate but only a slightly higher readmission rate than thoracoscopic resection. More complications occurred after discharge after thoracoscopic than open resections. Most readmissions occurred within 2 weeks after both thoracoscopic and open resections. Risk-adjusted comparison identified no statistically significant difference in risk of related, unplanned readmission after thoracoscopic versus open resections. Future studies should focus on identification of processes of care to decrease complications and unplanned readmissions after lung cancer resection.

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Incidence and Factors Associated With Hospital Readmission After Pulmonary Lobectomy

Cited by 27 publications

References 17 publications

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study

Socioeconomic Factors Are Associated With Readmission After Lobectomy for Early Stage Lung Cancer

National Analysis of Unplanned Readmissions After Thoracoscopic Versus Open Lung Cancer Resection

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