Readmission after Lobectomy for Lung Cancer: Not All Complications Contribute Equally

Lisa M. Brown, Dylan P. Thibault, Andrzej S. Kosinski, David T. Cooke, Mark W. Onaitis, Henning A. Gaissert, Patrick S. Romano

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this study was to identify independent predictors of hospital readmission for patients undergoing lobectomy for lung cancer. Summary Background Data: Hospital readmission after lobectomy is associated with increased mortality. Greater than 80% of the variability associated with readmission after surgery is at the patient level. This underscores the importance of using a data source that includes detailed clinical information. Methods: Using the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD), we conducted a retrospective cohort study of patients undergoing elective lobectomy for lung cancer. Three separate multivariable logistic regression models were generated: the first included preoperative variables, the second added intraoperative variables, and the third added postoperative variables. The c statistic was calculated for each model. Results: There were 39,734 patients from 277 centers. The 30-day readmission rate was 8.2% (n = 3237). In the final model, postoperative complications had the greatest effect on readmission. Pulmonary embolus {odds ratio [OR] 12.34 [95% confidence interval (CI),7.94-19.18]} and empyema, [OR 11.66 (95% CI, 7.31-18.63)] were associated with the greatest odds of readmission, followed by pleural effusion [OR 7.52 (95% CI, 6.01-9.41)], pneumothorax [OR 5.08 (95% CI, 4.16-6.20)], central neurologic event [OR 3.67 (95% CI, 2.23-6.04)], pneumonia [OR 3.13 (95% CI, 2.43-4.05)], and myocardial infarction [OR 3.16 (95% CI, 1.71-5.82)]. The c statistic for the final model was 0.736. Conclusions: Complications are the main driver of readmission after lobectomy for lung cancer. The highest risk was related to postoperative events requiring a procedure or medical therapy necessitating inpatient care.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Lung Neoplasms
Odds Ratio
Confidence Intervals
Patient Readmission
Logistic Models
Empyema
Information Storage and Retrieval
Pneumothorax
Pleural Effusion
Embolism
Thoracic Surgery
Inpatients
Pneumonia
Cohort Studies
Central Nervous System
Retrospective Studies
Myocardial Infarction
Databases
Lung
Mortality

Keywords

  • Lobectomy
  • readmission
  • thoracic surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Readmission after Lobectomy for Lung Cancer : Not All Complications Contribute Equally. / Brown, Lisa M.; Thibault, Dylan P.; Kosinski, Andrzej S.; Cooke, David T.; Onaitis, Mark W.; Gaissert, Henning A.; Romano, Patrick S.

In: Annals of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objective: The aim of this study was to identify independent predictors of hospital readmission for patients undergoing lobectomy for lung cancer. Summary Background Data: Hospital readmission after lobectomy is associated with increased mortality. Greater than 80{\%} of the variability associated with readmission after surgery is at the patient level. This underscores the importance of using a data source that includes detailed clinical information. Methods: Using the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD), we conducted a retrospective cohort study of patients undergoing elective lobectomy for lung cancer. Three separate multivariable logistic regression models were generated: the first included preoperative variables, the second added intraoperative variables, and the third added postoperative variables. The c statistic was calculated for each model. Results: There were 39,734 patients from 277 centers. The 30-day readmission rate was 8.2{\%} (n = 3237). In the final model, postoperative complications had the greatest effect on readmission. Pulmonary embolus {odds ratio [OR] 12.34 [95{\%} confidence interval (CI),7.94-19.18]} and empyema, [OR 11.66 (95{\%} CI, 7.31-18.63)] were associated with the greatest odds of readmission, followed by pleural effusion [OR 7.52 (95{\%} CI, 6.01-9.41)], pneumothorax [OR 5.08 (95{\%} CI, 4.16-6.20)], central neurologic event [OR 3.67 (95{\%} CI, 2.23-6.04)], pneumonia [OR 3.13 (95{\%} CI, 2.43-4.05)], and myocardial infarction [OR 3.16 (95{\%} CI, 1.71-5.82)]. The c statistic for the final model was 0.736. Conclusions: Complications are the main driver of readmission after lobectomy for lung cancer. The highest risk was related to postoperative events requiring a procedure or medical therapy necessitating inpatient care.",
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T2 - Not All Complications Contribute Equally

AU - Brown, Lisa M.

AU - Thibault, Dylan P.

AU - Kosinski, Andrzej S.

AU - Cooke, David T.

AU - Onaitis, Mark W.

AU - Gaissert, Henning A.

AU - Romano, Patrick S.

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N2 - Objective: The aim of this study was to identify independent predictors of hospital readmission for patients undergoing lobectomy for lung cancer. Summary Background Data: Hospital readmission after lobectomy is associated with increased mortality. Greater than 80% of the variability associated with readmission after surgery is at the patient level. This underscores the importance of using a data source that includes detailed clinical information. Methods: Using the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD), we conducted a retrospective cohort study of patients undergoing elective lobectomy for lung cancer. Three separate multivariable logistic regression models were generated: the first included preoperative variables, the second added intraoperative variables, and the third added postoperative variables. The c statistic was calculated for each model. Results: There were 39,734 patients from 277 centers. The 30-day readmission rate was 8.2% (n = 3237). In the final model, postoperative complications had the greatest effect on readmission. Pulmonary embolus {odds ratio [OR] 12.34 [95% confidence interval (CI),7.94-19.18]} and empyema, [OR 11.66 (95% CI, 7.31-18.63)] were associated with the greatest odds of readmission, followed by pleural effusion [OR 7.52 (95% CI, 6.01-9.41)], pneumothorax [OR 5.08 (95% CI, 4.16-6.20)], central neurologic event [OR 3.67 (95% CI, 2.23-6.04)], pneumonia [OR 3.13 (95% CI, 2.43-4.05)], and myocardial infarction [OR 3.16 (95% CI, 1.71-5.82)]. The c statistic for the final model was 0.736. Conclusions: Complications are the main driver of readmission after lobectomy for lung cancer. The highest risk was related to postoperative events requiring a procedure or medical therapy necessitating inpatient care.

AB - Objective: The aim of this study was to identify independent predictors of hospital readmission for patients undergoing lobectomy for lung cancer. Summary Background Data: Hospital readmission after lobectomy is associated with increased mortality. Greater than 80% of the variability associated with readmission after surgery is at the patient level. This underscores the importance of using a data source that includes detailed clinical information. Methods: Using the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD), we conducted a retrospective cohort study of patients undergoing elective lobectomy for lung cancer. Three separate multivariable logistic regression models were generated: the first included preoperative variables, the second added intraoperative variables, and the third added postoperative variables. The c statistic was calculated for each model. Results: There were 39,734 patients from 277 centers. The 30-day readmission rate was 8.2% (n = 3237). In the final model, postoperative complications had the greatest effect on readmission. Pulmonary embolus {odds ratio [OR] 12.34 [95% confidence interval (CI),7.94-19.18]} and empyema, [OR 11.66 (95% CI, 7.31-18.63)] were associated with the greatest odds of readmission, followed by pleural effusion [OR 7.52 (95% CI, 6.01-9.41)], pneumothorax [OR 5.08 (95% CI, 4.16-6.20)], central neurologic event [OR 3.67 (95% CI, 2.23-6.04)], pneumonia [OR 3.13 (95% CI, 2.43-4.05)], and myocardial infarction [OR 3.16 (95% CI, 1.71-5.82)]. The c statistic for the final model was 0.736. Conclusions: Complications are the main driver of readmission after lobectomy for lung cancer. The highest risk was related to postoperative events requiring a procedure or medical therapy necessitating inpatient care.

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