National evaluation of hospital readmission after pulmonary resection

Ravi Rajaram; Mila H. Ju; Karl Y. Bilimoria; Clifford Y. Ko; Malcolm M. Decamp

doi:10.1016/j.jtcvs.2015.05.047

National evaluation of hospital readmission after pulmonary resection

Ravi Rajaram^*, Mila H. Ju, Karl Y. Bilimoria, Clifford Y. Ko, Malcolm M. Decamp

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

36 Scopus citations

Abstract

Objectives Our objectives were to (1) assess readmission rates and timing after pulmonary resection, (2) report the most common reasons for rehospitalization, and (3) identify risk factors for unplanned readmission after pulmonary resection. Methods Patients who underwent pulmonary resection were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. We examined readmission within 30 days of surgery for all resections and 3 subgroups: open lobectomy, video-assisted thoracoscopic lobectomy, and pneumonectomy. Regression models were developed to identify factors associated with readmission. Results In 1847 patients, there were 899 open lobectomies (49%), 724 video-assisted thoracoscopic lobectomies (39%), and 85 pneumonectomies (5%). The overall readmission rate was 9.3% with no significant difference found among patients undergoing open lobectomy (9.1%), video-assisted thoracoscopic lobectomy (8.4%), or pneumonectomy (11.8%) (P =.576). The median time from operation to readmission was similar among patients undergoing open (14 days) or video-assisted thoracoscopic lobectomy (13 days). The most common cause of readmission for all groups examined was pulmonary related. In multivariable analyses, the strongest factor associated with readmission was an inpatient complication after the initial surgery in all resections (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.05-6.04), open lobectomy (HR, 4.36; 95% CI, 2.75-6.94), and video-assisted thoracoscopic lobectomy (HR, 4.60; 95% CI, 2.65-7.97). Surgical approach was not associated with readmission (video-assisted thoracoscopic vs open lobectomy: HR, 1.07; 95% CI, 0.75-1.52). Conclusions Experiencing a postoperative complication was strongly associated with unplanned readmission. Increased attention toward reducing postoperative complications and earlier outpatient follow-up in these patients may be a viable strategy for decreasing readmissions after pulmonary resection.

Original language	English (US)
Pages (from-to)	1508-1514.e2
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	150
Issue number	6
DOIs	https://doi.org/10.1016/j.jtcvs.2015.05.047
State	Published - Dec 2015

Funding

This work was supported by the American College of Surgeons Clinical Scholars in Residence Program to RR and MHJ; American Cancer Society to KYB; National Institutes of Health 5T32HL094293 to MHJ; an unrestricted educational grant from Merck to RR; and the Agency for Healthcare Research and Quality T32HS000078 to RR. Funding sources did not have any input into the selection of research topic, study interpretation, or any resulting presentation or publication of the submitted work.

Keywords

Centers for Medicare and Medicaid Services
Patient readmission
health care
pneumonectomy
postoperative complications
pulmonary surgical procedures
quality indicators
risk factors
thoracic surgery
video-assisted

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jtcvs.2015.05.047

Cite this

@article{7925db64731f42caa5be76681ee72079,

title = "National evaluation of hospital readmission after pulmonary resection",

abstract = "Objectives Our objectives were to (1) assess readmission rates and timing after pulmonary resection, (2) report the most common reasons for rehospitalization, and (3) identify risk factors for unplanned readmission after pulmonary resection. Methods Patients who underwent pulmonary resection were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. We examined readmission within 30 days of surgery for all resections and 3 subgroups: open lobectomy, video-assisted thoracoscopic lobectomy, and pneumonectomy. Regression models were developed to identify factors associated with readmission. Results In 1847 patients, there were 899 open lobectomies (49%), 724 video-assisted thoracoscopic lobectomies (39%), and 85 pneumonectomies (5%). The overall readmission rate was 9.3% with no significant difference found among patients undergoing open lobectomy (9.1%), video-assisted thoracoscopic lobectomy (8.4%), or pneumonectomy (11.8%) (P =.576). The median time from operation to readmission was similar among patients undergoing open (14 days) or video-assisted thoracoscopic lobectomy (13 days). The most common cause of readmission for all groups examined was pulmonary related. In multivariable analyses, the strongest factor associated with readmission was an inpatient complication after the initial surgery in all resections (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.05-6.04), open lobectomy (HR, 4.36; 95% CI, 2.75-6.94), and video-assisted thoracoscopic lobectomy (HR, 4.60; 95% CI, 2.65-7.97). Surgical approach was not associated with readmission (video-assisted thoracoscopic vs open lobectomy: HR, 1.07; 95% CI, 0.75-1.52). Conclusions Experiencing a postoperative complication was strongly associated with unplanned readmission. Increased attention toward reducing postoperative complications and earlier outpatient follow-up in these patients may be a viable strategy for decreasing readmissions after pulmonary resection.",

keywords = "Centers for Medicare and Medicaid Services, Patient readmission, health care, pneumonectomy, postoperative complications, pulmonary surgical procedures, quality indicators, risk factors, thoracic surgery, video-assisted",

author = "Ravi Rajaram and Ju, {Mila H.} and Bilimoria, {Karl Y.} and Ko, {Clifford Y.} and Decamp, {Malcolm M.}",

note = "Funding Information: This work was supported by the American College of Surgeons Clinical Scholars in Residence Program to RR and MHJ; American Cancer Society to KYB; National Institutes of Health 5T32HL094293 to MHJ; an unrestricted educational grant from Merck to RR; and the Agency for Healthcare Research and Quality T32HS000078 to RR. Funding sources did not have any input into the selection of research topic, study interpretation, or any resulting presentation or publication of the submitted work. Publisher Copyright: {\textcopyright} 2015 The American Association for Thoracic Surgery.",

year = "2015",

month = dec,

doi = "10.1016/j.jtcvs.2015.05.047",

language = "English (US)",

volume = "150",

pages = "1508--1514.e2",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Elsevier Inc.",

number = "6",

}

TY - JOUR

T1 - National evaluation of hospital readmission after pulmonary resection

AU - Rajaram, Ravi

AU - Ju, Mila H.

AU - Bilimoria, Karl Y.

AU - Ko, Clifford Y.

AU - Decamp, Malcolm M.

N1 - Funding Information: This work was supported by the American College of Surgeons Clinical Scholars in Residence Program to RR and MHJ; American Cancer Society to KYB; National Institutes of Health 5T32HL094293 to MHJ; an unrestricted educational grant from Merck to RR; and the Agency for Healthcare Research and Quality T32HS000078 to RR. Funding sources did not have any input into the selection of research topic, study interpretation, or any resulting presentation or publication of the submitted work. Publisher Copyright: © 2015 The American Association for Thoracic Surgery.

PY - 2015/12

Y1 - 2015/12

N2 - Objectives Our objectives were to (1) assess readmission rates and timing after pulmonary resection, (2) report the most common reasons for rehospitalization, and (3) identify risk factors for unplanned readmission after pulmonary resection. Methods Patients who underwent pulmonary resection were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. We examined readmission within 30 days of surgery for all resections and 3 subgroups: open lobectomy, video-assisted thoracoscopic lobectomy, and pneumonectomy. Regression models were developed to identify factors associated with readmission. Results In 1847 patients, there were 899 open lobectomies (49%), 724 video-assisted thoracoscopic lobectomies (39%), and 85 pneumonectomies (5%). The overall readmission rate was 9.3% with no significant difference found among patients undergoing open lobectomy (9.1%), video-assisted thoracoscopic lobectomy (8.4%), or pneumonectomy (11.8%) (P =.576). The median time from operation to readmission was similar among patients undergoing open (14 days) or video-assisted thoracoscopic lobectomy (13 days). The most common cause of readmission for all groups examined was pulmonary related. In multivariable analyses, the strongest factor associated with readmission was an inpatient complication after the initial surgery in all resections (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.05-6.04), open lobectomy (HR, 4.36; 95% CI, 2.75-6.94), and video-assisted thoracoscopic lobectomy (HR, 4.60; 95% CI, 2.65-7.97). Surgical approach was not associated with readmission (video-assisted thoracoscopic vs open lobectomy: HR, 1.07; 95% CI, 0.75-1.52). Conclusions Experiencing a postoperative complication was strongly associated with unplanned readmission. Increased attention toward reducing postoperative complications and earlier outpatient follow-up in these patients may be a viable strategy for decreasing readmissions after pulmonary resection.

AB - Objectives Our objectives were to (1) assess readmission rates and timing after pulmonary resection, (2) report the most common reasons for rehospitalization, and (3) identify risk factors for unplanned readmission after pulmonary resection. Methods Patients who underwent pulmonary resection were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. We examined readmission within 30 days of surgery for all resections and 3 subgroups: open lobectomy, video-assisted thoracoscopic lobectomy, and pneumonectomy. Regression models were developed to identify factors associated with readmission. Results In 1847 patients, there were 899 open lobectomies (49%), 724 video-assisted thoracoscopic lobectomies (39%), and 85 pneumonectomies (5%). The overall readmission rate was 9.3% with no significant difference found among patients undergoing open lobectomy (9.1%), video-assisted thoracoscopic lobectomy (8.4%), or pneumonectomy (11.8%) (P =.576). The median time from operation to readmission was similar among patients undergoing open (14 days) or video-assisted thoracoscopic lobectomy (13 days). The most common cause of readmission for all groups examined was pulmonary related. In multivariable analyses, the strongest factor associated with readmission was an inpatient complication after the initial surgery in all resections (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.05-6.04), open lobectomy (HR, 4.36; 95% CI, 2.75-6.94), and video-assisted thoracoscopic lobectomy (HR, 4.60; 95% CI, 2.65-7.97). Surgical approach was not associated with readmission (video-assisted thoracoscopic vs open lobectomy: HR, 1.07; 95% CI, 0.75-1.52). Conclusions Experiencing a postoperative complication was strongly associated with unplanned readmission. Increased attention toward reducing postoperative complications and earlier outpatient follow-up in these patients may be a viable strategy for decreasing readmissions after pulmonary resection.

KW - Centers for Medicare and Medicaid Services

KW - Patient readmission

KW - health care

KW - pneumonectomy

KW - postoperative complications

KW - pulmonary surgical procedures

KW - quality indicators

KW - risk factors

KW - thoracic surgery

KW - video-assisted

UR - http://www.scopus.com/inward/record.url?scp=84948710602&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84948710602&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2015.05.047

DO - 10.1016/j.jtcvs.2015.05.047

M3 - Article

C2 - 26092506

AN - SCOPUS:84948710602

SN - 0022-5223

VL - 150

SP - 1508-1514.e2

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 6

ER -

National evaluation of hospital readmission after pulmonary resection

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this