Unplanned Readmission After Lung Resection: Complete Follow-Up in a 1-Year Cohort With Identification of Associated Risk Factors

Karen J. Dickinson, James B. Taswell, Mark S. Allen, Shanda H. Blackmon, Francis C. Nichols, Robert Shen, Dennis A Wigle, Stephen D. Cassivi

Research output: Contribution to journalArticle

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Abstract

Background: Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors. Methods: All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service. Demographic data were supplemented from our prospectively maintained database. Follow-up was complete in 100% of patients. Results: Over the 12-month study period, 582 lung resections were performed. Five hundred fifty-four resections in 532 patients were performed with the thoracic surgical service as the primary service. Of these patients, 505 undergoing 521 resections consented for their data to be included in the study, and they all survived to 30 days. Mean age was 62.3 years (standard deviation [SD], 13.8 years). The male to female ratio was 265:240. Fifteen pneumonectomies, 222 lesser anatomic resections in 215 patients, and 270 nonanatomic (wedge) resections in 261 patients were performed; 14 other miscellaneous resections were performed in 14 patients. Thirty-day mortality was 1% (5 of 510 patients). There were 4 in-hospital deaths and 1 additional mortality within 30 days. Unplanned readmissions occurred in 42 patients (42 of 505 patients [8.3%])-28 (67%) at our institution and 14 (33%) at other institutions. The median interval to readmission was 14 days. Readmissions occurred in 7.3% of patients discharged home, whereas 19.4% of patients discharged to a nursing home or other facility required readmission (p = 0.041). The most common reason for readmission was respiratory complications (47%). Significant factors (p < 0.05) associated with increased risk of readmission were lower percent predicted forced expiratory volume in 1 second (FEV1), longer operative time, perioperative furosemide administration, pain score of 6 or greater between 12 and 24 hours after the operation, prolonged air leakage (>5 days), blood transfusion, and discharge to a nursing home. Length of stay after lung resection was not a risk factor for unplanned readmission. Conclusions: The unplanned readmission rate after lung resection for our cohort was 8.3%, with half resulting from respiratory issues. Risk factors in the preoperative, perioperative, and postoperative setting were identified that may provide opportunities for mitigating these adverse events.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2016

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Lung
Nursing Homes
Pneumonectomy
Mortality
Health Resources
Blood Transfusion
Length of Stay
Thorax
Demography
Databases
Delivery of Health Care

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Dickinson, K. J., Taswell, J. B., Allen, M. S., Blackmon, S. H., Nichols, F. C., Shen, R., ... Cassivi, S. D. (Accepted/In press). Unplanned Readmission After Lung Resection: Complete Follow-Up in a 1-Year Cohort With Identification of Associated Risk Factors. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2016.09.065

Unplanned Readmission After Lung Resection : Complete Follow-Up in a 1-Year Cohort With Identification of Associated Risk Factors. / Dickinson, Karen J.; Taswell, James B.; Allen, Mark S.; Blackmon, Shanda H.; Nichols, Francis C.; Shen, Robert; Wigle, Dennis A; Cassivi, Stephen D.

In: Annals of Thoracic Surgery, 2016.

Research output: Contribution to journalArticle

Dickinson, Karen J. ; Taswell, James B. ; Allen, Mark S. ; Blackmon, Shanda H. ; Nichols, Francis C. ; Shen, Robert ; Wigle, Dennis A ; Cassivi, Stephen D. / Unplanned Readmission After Lung Resection : Complete Follow-Up in a 1-Year Cohort With Identification of Associated Risk Factors. In: Annals of Thoracic Surgery. 2016.
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abstract = "Background: Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors. Methods: All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service. Demographic data were supplemented from our prospectively maintained database. Follow-up was complete in 100{\%} of patients. Results: Over the 12-month study period, 582 lung resections were performed. Five hundred fifty-four resections in 532 patients were performed with the thoracic surgical service as the primary service. Of these patients, 505 undergoing 521 resections consented for their data to be included in the study, and they all survived to 30 days. Mean age was 62.3 years (standard deviation [SD], 13.8 years). The male to female ratio was 265:240. Fifteen pneumonectomies, 222 lesser anatomic resections in 215 patients, and 270 nonanatomic (wedge) resections in 261 patients were performed; 14 other miscellaneous resections were performed in 14 patients. Thirty-day mortality was 1{\%} (5 of 510 patients). There were 4 in-hospital deaths and 1 additional mortality within 30 days. Unplanned readmissions occurred in 42 patients (42 of 505 patients [8.3{\%}])-28 (67{\%}) at our institution and 14 (33{\%}) at other institutions. The median interval to readmission was 14 days. Readmissions occurred in 7.3{\%} of patients discharged home, whereas 19.4{\%} of patients discharged to a nursing home or other facility required readmission (p = 0.041). The most common reason for readmission was respiratory complications (47{\%}). Significant factors (p < 0.05) associated with increased risk of readmission were lower percent predicted forced expiratory volume in 1 second (FEV1), longer operative time, perioperative furosemide administration, pain score of 6 or greater between 12 and 24 hours after the operation, prolonged air leakage (>5 days), blood transfusion, and discharge to a nursing home. Length of stay after lung resection was not a risk factor for unplanned readmission. Conclusions: The unplanned readmission rate after lung resection for our cohort was 8.3{\%}, with half resulting from respiratory issues. Risk factors in the preoperative, perioperative, and postoperative setting were identified that may provide opportunities for mitigating these adverse events.",
author = "Dickinson, {Karen J.} and Taswell, {James B.} and Allen, {Mark S.} and Blackmon, {Shanda H.} and Nichols, {Francis C.} and Robert Shen and Wigle, {Dennis A} and Cassivi, {Stephen D.}",
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T2 - Complete Follow-Up in a 1-Year Cohort With Identification of Associated Risk Factors

AU - Dickinson, Karen J.

AU - Taswell, James B.

AU - Allen, Mark S.

AU - Blackmon, Shanda H.

AU - Nichols, Francis C.

AU - Shen, Robert

AU - Wigle, Dennis A

AU - Cassivi, Stephen D.

PY - 2016

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N2 - Background: Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors. Methods: All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service. Demographic data were supplemented from our prospectively maintained database. Follow-up was complete in 100% of patients. Results: Over the 12-month study period, 582 lung resections were performed. Five hundred fifty-four resections in 532 patients were performed with the thoracic surgical service as the primary service. Of these patients, 505 undergoing 521 resections consented for their data to be included in the study, and they all survived to 30 days. Mean age was 62.3 years (standard deviation [SD], 13.8 years). The male to female ratio was 265:240. Fifteen pneumonectomies, 222 lesser anatomic resections in 215 patients, and 270 nonanatomic (wedge) resections in 261 patients were performed; 14 other miscellaneous resections were performed in 14 patients. Thirty-day mortality was 1% (5 of 510 patients). There were 4 in-hospital deaths and 1 additional mortality within 30 days. Unplanned readmissions occurred in 42 patients (42 of 505 patients [8.3%])-28 (67%) at our institution and 14 (33%) at other institutions. The median interval to readmission was 14 days. Readmissions occurred in 7.3% of patients discharged home, whereas 19.4% of patients discharged to a nursing home or other facility required readmission (p = 0.041). The most common reason for readmission was respiratory complications (47%). Significant factors (p < 0.05) associated with increased risk of readmission were lower percent predicted forced expiratory volume in 1 second (FEV1), longer operative time, perioperative furosemide administration, pain score of 6 or greater between 12 and 24 hours after the operation, prolonged air leakage (>5 days), blood transfusion, and discharge to a nursing home. Length of stay after lung resection was not a risk factor for unplanned readmission. Conclusions: The unplanned readmission rate after lung resection for our cohort was 8.3%, with half resulting from respiratory issues. Risk factors in the preoperative, perioperative, and postoperative setting were identified that may provide opportunities for mitigating these adverse events.

AB - Background: Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors. Methods: All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service. Demographic data were supplemented from our prospectively maintained database. Follow-up was complete in 100% of patients. Results: Over the 12-month study period, 582 lung resections were performed. Five hundred fifty-four resections in 532 patients were performed with the thoracic surgical service as the primary service. Of these patients, 505 undergoing 521 resections consented for their data to be included in the study, and they all survived to 30 days. Mean age was 62.3 years (standard deviation [SD], 13.8 years). The male to female ratio was 265:240. Fifteen pneumonectomies, 222 lesser anatomic resections in 215 patients, and 270 nonanatomic (wedge) resections in 261 patients were performed; 14 other miscellaneous resections were performed in 14 patients. Thirty-day mortality was 1% (5 of 510 patients). There were 4 in-hospital deaths and 1 additional mortality within 30 days. Unplanned readmissions occurred in 42 patients (42 of 505 patients [8.3%])-28 (67%) at our institution and 14 (33%) at other institutions. The median interval to readmission was 14 days. Readmissions occurred in 7.3% of patients discharged home, whereas 19.4% of patients discharged to a nursing home or other facility required readmission (p = 0.041). The most common reason for readmission was respiratory complications (47%). Significant factors (p < 0.05) associated with increased risk of readmission were lower percent predicted forced expiratory volume in 1 second (FEV1), longer operative time, perioperative furosemide administration, pain score of 6 or greater between 12 and 24 hours after the operation, prolonged air leakage (>5 days), blood transfusion, and discharge to a nursing home. Length of stay after lung resection was not a risk factor for unplanned readmission. Conclusions: The unplanned readmission rate after lung resection for our cohort was 8.3%, with half resulting from respiratory issues. Risk factors in the preoperative, perioperative, and postoperative setting were identified that may provide opportunities for mitigating these adverse events.

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