R. A. Jean1,2, A. S. Chiu1, J. D. Blasberg3, D. J. Boffa3, F. C. Detterbeck3, A. W. Kim4 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 4Keck School Of Medicine Of USC,Division Of Thoracic Surgery, Department Of Surgery,Los Angeles, CA, USA
Introduction: Hospital readmission after cardiothoracic surgery has a significant effect on healthcare delivery, particularly in the era of value-based reimbursement. Studies have shown that readmission after major surgery is significantly associated with preoperative comorbidity burden and the development of postoperative complications. We sought to investigate the additive impact of comorbidity and postoperative complications on the risk of readmission after thoracic lobectomy, and compare which of these factors were driving this phenomenon.
Methods: The Healthcare Cost and Utilization Project’s Nationwide Readmission Database (NRD) between 2010 and 2014 was used as the dataset for this study. The NRD was queried for discharges for pulmonary lobectomy with a primary diagnosis of lung cancer. Patients surviving to discharge were followed for rates of 90-day readmision. Readmission rates were calculated for low-risk patients who had no comorbidity and no postoperative complications. Next, rates were compared iteratively by the presence of Elixhauser comorbidity and postoperative complications. Adjusted linear regression, accounting for patient age, sex, insurance status, and income, was used to calculate the mean change in readmission rate by the number of comorbidities and postoperative complications.
Results: A total of 106,262 pulmonary lobectomies were identified over the study period, of whom 20,112 (18.9%) were readmitted within 90 days of discharge. Of this total cohort, the mean age was 67.7 ± 0.11 years, with a mean of 2.5 Elixhauser comorbidities and an mean incidence of 0.8 postoperative complications per patient. Of the 5812 (5.5%) patients with no comorbidities or postoperative complications, 680 (11.7%) were readmitted. At the other extreme, of the 6121 (5.8%) of patients with 3+ comorbidities and 3+ complications, 1877 (30.7%) of patients were readmitted. After adjusting for age, sex, and insurance status, each additional comorbidity and any postoperative complication were associated with a 2.3% (95% CI 2.0% – 2.6%) and 2.7% (95% CI 2.3% – 3.2%) increased probability of readmission, respectively.
Conclusion: Among patients with the lowest risk profile, there was an 11.7% 90-day readmission rate. Adjusting for other factors, each additional comorbidity increased this rate by approximately 2.3%, while each postoperative complication increased this rate by 2.7%. These results demonstrate that even among optimized patients without postoperative complications, there remains notable risk of rehospitalization, indicating that careful patient selection and the avoidance of complications may not completely reduce readmission risk after pulmonary lobectomy.
