Risk Factors for Readmission After Pulmonary Lobectomy: A Quality Collaborative Study

Previous studies have identified postoperative complications as being associated with readmission after lobectomy. However, these studies have not adequately accounted for the timing of complications or accounted for institutional effects. Our objectives were to examine readmission rates after lobectomy and identify factors associated with readmission.

Patients aged >18 years undergoing lobectomy for lung cancer between 2015 and 2019 were identified from a statewide database. Patients with in-hospital mortality, missing data regarding discharge status, 30-day readmission status, and discharge location were excluded. Data regarding The Society of Thoracic Surgeons postoperative complications were abstracted by hospital data managers to determine the timing of occurrence (index admission vs readmission). Logistic mixed-model analysis, with hospitals as the random intercept to account for clustering data structure and assess hospital-specific effect on readmission, was performed.

The overall readmission rate was 6.9% (184 of 2686). The most common complication was air leak ≥5 days in 17.4% (467 of 2686). Variables significantly predictive of more readmission were predischarge postoperative complications and Zubrod score ≥1. Variables predictive of less readmission were increasing length of stay and having been operated on at institutions with higher cumulative volume or having postdischarge follow-up visit protocol ≤7 days from discharge. The C statistic for the final model was 0.80.

Patients who experience postoperative complications are at increased risk for readmission, whereas follow-up ≤7 days was predictive of less risk for readmission. Efforts at reducing readmissions should focus on decreasing postoperative complication rates, the timing of discharge for patients experiencing complications, as well as decreasing length of time between discharge and clinic follow-up.