Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality

Abstract

Objectives Postoperative readmission impacts patient care and healthcare costs. There is a paucity of nation-wide data describing the clinical significance of readmission following thoracic operations. The purpose of this study was to evaluate the relationship between postoperative readmission and mortality following lung cancer resection. Methods Data were extracted for lung cancer resection patients from the linked SEER-Medicare registry (2006-2011), including demographics, comorbidities, socioeconomic factors, readmission within 30 days from discharge, and 90-day mortality. Readmitting facility and diagnoses were identified. A hierarchical regression model clustered at the hospital level identified predictors of readmission. Results We identified 11,432 lung cancer resection patients discharged alive from 677 hospitals. The median age was 74.5 years and 52% of patients received an open lobectomy. 30-day readmission rate was 12.8%, and 28.3% of readmissions were to facilities that did not perform the original operation. Readmission was associated with a six-fold increase in 90-day mortality (14.4% vs. 2.5%, p <0.001). The most common readmitting diagnoses were respiratory insufficiency, pneumonia, pneumothorax, and cardiac complications. Patient factors associated with readmission included resection type, age, prior induction chemoradiation, preoperative comorbidities including congestive heart failure and COPD, and low regional population density. Conclusions Factors associated with early readmission following lung cancer resection include patient comorbidities, type of operation, and socioeconomic factors. Metrics that only report readmissions to the operative provider miss one-fourth of all cases. Importantly, readmitted patients have an increased risk of death and demand maximum attention and optimal care.

Long-term impact of developing a postoperative pulmonary complication after lung surgery

“…Hospital readmission is not only a serious morbidity; we demonstrate it is also an independent risk factor for the late deaths observed in our study. Patients who are readmitted within 30 days of lung cancer surgery have been shown to have a sixfold increase in 90-day postoperative mortality 17. In our study the 90-day mortality was 2.6 times that of 30-day mortality, compatible with other study findings 9 18.…”

National evaluation of hospital readmission after pulmonary resection

“…They also reported the most common causes of readmission were pulmonary and cardiac-related problems. 10 In our study, we found readmission rates to be similar, although lower, to those of other studies examining pulmonary resection. This may reflect the difference in reporting readmission 30 days from the operative date rather than 30 days from discharge.…”

“…Reports that have been published regarding pulmonary resection are older, regional studies or make use of administrative data in a primarily elderly population. [9][10][11] Moreover, the association between postoperative inpatient complications and readmissions, although reported in other fields, has not been well established after pulmonary resection. 4,7 Our objectives for this study were (1) to describe the prevalence and timing of readmission after pulmonary resection, (2) to report the primary causes of rehospitalization, and (3) to identify risk factors for unplanned readmission after pulmonary resection.…”

High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England

“…The results for length of stay and re-admission emphasise that other relevant outcomes vary along the gradient from low hospital volume (and high mortality) to high volume (and lower mortality). A number of recent studies have explored associations within the wider set of outcomes: hospital volume, length of stay, complications, re-admission, mortality, and cost (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). None of these papers addresses all of the possible associations, but the emerging pattern is one of correlated and consistently favourable outcomes in high-volume hospitals.…”