Factors Associated with Unexpected Readmission Following Lung Resection

Abstract

Background Identification of the predictors of readmission can facilitate appropriate perioperative management. The current study aimed to investigate the potential predictors of unexpected readmission after lung resection for primary lung cancers. Methods This retrospective study enrolled 1000 patients who underwent pulmonary resection for lung cancer at our institution between January 2016 and December 2017. Unexpected readmission was defined as unscheduled readmission to our hospital within 30 days after discharge. Univariate and multivariate analyses were performed for identification of perioperative factors associated with readmission. Results Forty‐three patients (4.3%) required unexpected readmission, and the median interval between the day of discharge and readmission was 10 days (range 1–29 days). The reasons for readmission included empyema and pleural effusion (n = 11), acute exacerbation of idiopathic pulmonary fibrosis (n = 7), pneumothorax (n = 7), and others (n = 18). The median hospitalization length after readmission was 14 days (range 2–90 days). Four patients (9.3%) died in the hospital because of acute exacerbation of idiopathic pulmonary fibrosis after readmission. In multivariate logistic regression analysis, postoperative refractory air leakage, defined as prolonged air leakage lasting > 5 days or requiring reoperation, was identified as a significant predictor associated with an increased risk of readmission (odds ratio 2.87; 95% confidence interval 1.22–6.72; p = 0.015). Conclusions Unexpected readmission was an inevitable event following lung resection. Patients with readmission had an increased risk of death. Refractory air leakage after lung resection for primary lung cancer was strongly associated with unexpected readmission.

Predictors of Readmission After Pulmonary Resection in Patients With Lung Cancer: A Systematic Review and Meta-analysis

“…Five literatures were screened for the association of cigret smoking, diabetes mellitus (DM) with readmission after pulmonary resection for lung cancer. Three of them 8 , 14 , 16 indicated that smoking and DM were related to hospital readmission, while others did not. 4 , 7 Subgroup analyses indicated that hospital readmission increased in North Amercia ( P < .05) and Asian ( P < .05), but not in Europe ( P > .05) ( Tables 2 and 4 ).…”

“…17,18 However, we found that 6 of them did not mention whether patients were readmitted in the same hospital or another institution clearly. 4,8,13,14,16,19 A pooled analysis of nine (2 of 11 articles did not report original data of age) available studies showed that age was a risk factor for readmission (SMD = 0.093, P < .001), with a heterogeneity (I 2 = 77.7%) between the studies (Figure 2, Table 2). The results of metaregression analysis showed that type of surgery (P = .037) and readmission interval (P = .034) might be the source of heterogeneity between studies, while publication year, sample size, and ethnic group were not (all P > .05) (Table 3).…”

“…The screening process is shown in Figure 1. Finally, 11 articles were included in our study, 4,[6][7][8][13][14][15][16][17][18][19] involving a total of 386 012 participants. Of the 386 012 patients, 26 465 underwent readmission, while 359 547 did not undergo readmission.…”

“…Empyema was also reportedly the leading cause of unexpected readmission after pulmonary resection. 8 The identification of these risk factors can help in preventing readmissions that are caused by reversible factors such as postoperative air leaks and atelectasis. 7 For instance, improve preoperative patient healthy lifestyle education, adopt a more proactive smoking-cessation program before pulmonary resection; preoperative assessment of pulmonary function, and treatment for pneumonia with intravenous antibiotics.…”

“… 5 At present, risk factors for readmission after pulmonary resection in patients with lung cancer are still not fully elucidated, and related studies have shown inconclusive results. 6 – 8 For instance, unlike previous studies, Uchida et al 8 indicated that air leakage prevention during initial surgery is crucial to reduce the risk of hospital readmission. In contrast to previous studies, Quero-Valenzuela et al 7 showed that no correlation was found between the type of resection and readmission.…”