title: A population-based study of hospital length of stay and emergency readmission following surgery for non-small-cell lung cancer.
abstract: OBJECTIVE
  We conducted a population-based analysis of time trends in length of stay (LOS), predictors of prolonged LOS and emergency readmission following resection for non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Incident lung cancers (ICDO2:C34), diagnosed between 2002 and 2008, were identified from the National Cancer Registry (NCR) of Ireland, and linked to hospital in-patient episodes (HIPE). For those with NSCLC who underwent lung resection, the associated hospital episode was identified. Factors predicting longer LOS (upper quartile, >20 days), and emergency readmission within 28 days of the index procedure (IP) were investigated using Poisson regression.
  
  
  RESULTS
  A total of 1284 patients underwent resection. Eighty-four (7%) subsequently died in hospital and 1200 (93%) were discharged. Hundred and nineteen of 1200 (10%) were readmitted as an emergency within 28 days of discharge. Median LOS after the IP was 13 days (inter-decile range: 7-35). Risk of prolonged LOS was significantly greater in patients >75 years, resident in an area of highest deprivation, with 2+ comorbidities, who had undergone surgery in a lower-volume hospital, and died in hospital subsequent to the IP. Emergency readmission was significantly more likely in patients who were resident in an area of highest deprivation, with 2+ comorbidities, and had Stage III disease or worse. The main reasons for emergency readmission were: pulmonary complications (29%), cardio/cerebrovascular events (21%) or infection (20%).
  
  
  CONCLUSIONS
  Half of the patients had a LOS in excess of 13 days, which was longer than any other country with published data. Patient and health-service factors were associated with prolonged LOS, while patient and tumour characteristics were associated with risk of emergency readmission. Deprivation was a conspicuous determinant of both LOS and readmission.
authors.affiliation: National Cancer Registry Ireland, Cork, Ireland.
authors.forename: Joseph
authors.initials: J
authors.lastname: McDevitt
authors.forename: Maria
authors.initials: M
authors.lastname: Kelly
authors.forename: Harry
authors.initials: H
authors.lastname: Comber
authors.forename: Tracey
authors.initials: T
authors.lastname: Kelleher
authors.forename: Fiona
authors.initials: F
authors.lastname: Dwane
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay; D008175:Lung Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D016012:Poisson Distribution
keywords: Emergency readmission; Length of stay; Lobectomy; Pneumonectomy