Predictors of Need for Home Health Services at Discharge for Thoracic Surgery Patients

In patients undergoing general thoracic surgery, the need for home health (HH) services at discharge increases hospital length of stay. We sought to identify preoperative predictors of HH needs for these patients.

This was a single-institution, retrospective analysis of patients undergoing elective, nonambulatory thoracic surgical procedures from January 2017 through June 2021. Operations were categorized as "lung," "esophagus" or "other." We analyzed and compared preoperative characteristics, intraoperative events, and postoperative complications between HH and No-HH cohorts, including a multivariable logistic regression analysis to identify preoperative predictors for HH need.

We identified 429 patients, with 324 patients (75.5%) discharged without HH and 105 patients (24.5%) discharged with HH. The average length of stay for the No-HH cohort was 3.5 days compared with the HH group of 7.9 days (P < .0001). Multivariable analysis revealed age (adjusted odds ratio [aOR], 1.11; 95% CI, 1.10-1.16), clinical cancer stage II (aOR, 6.40; 95% CI, 2.13-19.23), and clinical cancer stage III and higher (aOR, 3.94; 95% CI, 1.12-13.84), preoperative opioid use (aOR, 10.30; 95% CI, 2.24-47.35), higher case mix index (CMI) score (aOR, 1.72; 95% CI, 1.26-2.35), and esophageal operation (aOR, 18.75; 95% C,I 4.70-74.81) as significantly associated with the need for HH.

We identified older age, advanced clinical cancer stage, preoperative opioid use, higher CMI score, and esophageal operation as predictors of the need for HH services. These data may allow for identification of at-risk patients in the ambulatory setting and initiation of HH logistics before admission.