Raymond A Jean1, Alexander S Chiu2, Daniel J Boffa3, Frank C Detterbeck3, Justin D Blasberg3, Anthony W Kim4. 1. Department of Surgery, Yale School of Medicine, New Haven, CT; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 2. Department of Surgery, Yale School of Medicine, New Haven, CT. 3. Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. 4. Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA. Electronic address: Anthony.Kim@med.usc.edu.
Abstract
BACKGROUND: Hospital readmission after major thoracic surgery has a marked effect on health care delivery, particularly in the era of value-based reimbursement. We sought to investigate the additive impact of comorbidity and postoperative complications on the risk of readmission after thoracic lobectomy. METHODS: We queried the Nationwide Readmission Database of the Healthcare Cost and Utilization Project between 2010 and 2014 for discharges after pulmonary lobectomy with a primary diagnosis of lung cancer. We compared 90-day all-cause readmission rates across the presence of Elixhauser comorbidities and postoperative complications. Adjusted logistic and linear regression, accounting for patient and hospital factors were used to calculate the mean change in readmission rate by the number of comorbidities and postoperative complications. RESULTS: A total of 87,894 patients undergoing pulmonary lobectomies were identified during the study period, of whom 15,858 (18.0%) were readmitted for any cause within 90 days of discharge. After adjusting for other factors, each additional comorbidity and postoperative complication were associated with a 2.0% and 2.7% increased probability of readmission, respectively (both P < .0001). Patients with a low burden of low comorbidities were readmitted more frequently for postoperative complications, while those with a high burden of comorbidities were readmitted more frequently for chronic disease. CONCLUSION: Among patients with the lowest risk profile, there was an 11.7% readmission rate. Adjusting for other factors, each additional comorbidity and complication increased this rate by approximately 2.0% and 2.7%, respectively. These results demonstrate that the avoidance of postoperative complications may represent an effective mechanism for decreasing readmissions after thoracic surgery.
BACKGROUND: Hospital readmission after major thoracic surgery has a marked effect on health care delivery, particularly in the era of value-based reimbursement. We sought to investigate the additive impact of comorbidity and postoperative complications on the risk of readmission after thoracic lobectomy. METHODS: We queried the Nationwide Readmission Database of the Healthcare Cost and Utilization Project between 2010 and 2014 for discharges after pulmonary lobectomy with a primary diagnosis of lung cancer. We compared 90-day all-cause readmission rates across the presence of Elixhauser comorbidities and postoperative complications. Adjusted logistic and linear regression, accounting for patient and hospital factors were used to calculate the mean change in readmission rate by the number of comorbidities and postoperative complications. RESULTS: A total of 87,894 patients undergoing pulmonary lobectomies were identified during the study period, of whom 15,858 (18.0%) were readmitted for any cause within 90 days of discharge. After adjusting for other factors, each additional comorbidity and postoperative complication were associated with a 2.0% and 2.7% increased probability of readmission, respectively (both P < .0001). Patients with a low burden of low comorbidities were readmitted more frequently for postoperative complications, while those with a high burden of comorbidities were readmitted more frequently for chronic disease. CONCLUSION: Among patients with the lowest risk profile, there was an 11.7% readmission rate. Adjusting for other factors, each additional comorbidity and complication increased this rate by approximately 2.0% and 2.7%, respectively. These results demonstrate that the avoidance of postoperative complications may represent an effective mechanism for decreasing readmissions after thoracic surgery.
Authors: Ricardo Mingarini Terra; Pedro Henrique Xavier Nabuco de Araujo; Leticia Leone Lauricella; Jose Ribas Milanese de Campos; Juliana Rocha Mol Trindade; Paulo Manuel Pêgo-Fernandes Journal: J Bras Pneumol Date: 2022-07-08 Impact factor: 2.800
Authors: Heloise Catho; Sebastien Guigard; Anne-Claire Toffart; Gil Frey; Thibaut Chollier; Pierre-Yves Brichon; Jean-François Roux; Linda Sakhri; Dominique Bertrand; Charles Aguirre; Sandy Gorain; Bernard Wuyam; François Arbib; Jean Christian Borel Journal: BMJ Open Date: 2021-02-10 Impact factor: 2.692