Identifying Drivers of Multiple Readmissions Following Pulmonary Lobectomy.

BACKGROUND: Readmissions after pulmonary lobectomy for lung cancer are important markers of healthcare quality for surgeons and hospitals. The implications on resources and quality are magnified when examining patients who require multiple readmissions within the perioperative period.

METHODS: The Nationwide Readmission Database (NRD) between 2013 and 2014 was investigated for patients with a primary diagnosis of lung cancer who underwent pulmonary lobectomy. Using adjusted hierarchical regression models, demographic and clinical factors during the index hospitalization were investigated for associations with single and multiple readmissions during the 90-day postoperative period. First and second readmissions during this period were compared for the primary diagnosis at the time of readmission using Clinical Classification Software (CCS) codes.

RESULTS: Of the 41,576 lobectomies during the study period, 7030 patients (16.9%) were readmitted. Among this group, 1554 patients (3.7%) had ≥2 readmissions. After adjustment for other factors, postoperative arrhythmia (OR 1.51 95% CI [1.25, 1.83], p<0.0001), postoperative infection (OR 1.55, 95% CI [1.11, 2.17], p=0.01) and postoperative sepsis (OR 1.70 95% CI [1.08, 2.67], p=0.02) during the index hospitalization were associated with an increased risk of ≥2 readmissions. The most frequent CCS diagnosis for first readmissions was "postoperative complications" (892, 12.7%), and for second readmissions was heart disease (173, 11.2%).

CONCLUSIONS: Approximately one-fifth of patients readmitted after pulmonary lobectomy would go on to be readmitted two or more times within 90-days. Although first readmissions were most likely to present with postoperative infection or complication, second readmissions were most likely to present with heart disease.