R. A. Jean1,2, A. S. Chiu1, D. J. Boffa3, A. W. Kim4, F. C. Detterbeck3, J. D. Blasberg3 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale University School Of Medicine,National Clinician Scholars Program,New Haven, CT, USA 3Yale University School Of Medicine,Section Of Thoracic Surgery, Department Of Surgery,New Haven, CT, USA 4University Of Southern California,Division Of Thoracic Surgery, Department Of Surgery,Los Angeles, CA, USA
Introduction: Readmission after pulmonary lobectomy has become an increasingly important measure of hospital quality, and a potentially avoidable source of healthcare costs. Expedited discharge within 3 days of pulmonary lobectomy for lung cancer has been used to reduce costs and hospital-associated complications. However, there is concern that expedited discharge put patients at risk for more frequent, and more expensive, postoperative readmissions. We sought to explore whether patients were at higher risk for costly readmission following expedited discharge.
Methods: The Healthcare Cost and Utilization Project’s Nationwide Readmission Database (NRD) was queried for cases of pulmonary lobectomy for lung cancer between 2010 and 2014. Patients aged 65 years and older, surviving to discharge, were categorized as “expedited” if they were discharged on hospital day 2 or 3, or “routine” if they were discharged between hospital days 4 and 7; all other patients were excluded from analysis. Patients were evaluated for 90-days following discharge to identify the primary endpoint of readmission. Risk-adjusted readmission rates and median hospital charge of the first readmission were compared between groups.
Results: A total of 46,287 patients underwent lobectomy for lung cancer during the study period. There were 10,447 (22.6%) expedited discharges and 35,840 (77.4%) routine discharges. Median charges for the index hospitalization were $49,037 (IQR $37,667 – $69,038) for the expedited group, and $63,009 (IQR $47,161 – $87,282) for the routine discharge group (p<0.0001). Patients in the routine discharge group had a 17.3% (N 6200; 95% CI 16.5% -18.1%) risk-adjusted probability of readmission, in comparison to a 14.2% (N 1486; 95% CI 13.0% – 18.1%) risk-adjusted rate among the expedited discharge group (p<0.0001). Despite this, there was no significant difference in the median charges following readmission for either group (Expedited $28,908 vs Routine $28,968, p=0.78).
Conclusion: Lobectomy patients with routine hospital length of stay had a 3.1% higher risk-adjusted readmission rate and almost $14,000 higher median index charges than patients following expedited discharge. Despite this, median charges for readmission were not different between groups. This data demonstrates that prolonged hospital length of stay does not reduce the risk of 90-day readmission following lobectomy, providing support for protocols that expedite patient discharge and in turn reduce overall healthcare utilization.
