title: Hospital readmission after pulmonary lobectomy is not affected by surgical approach.
abstract: BACKGROUND
  The aim of this study is to identify the predictors of hospital readmission or early unplanned return to clinic within 30 days of discharge after pulmonary lobectomy.
  
  
  METHODS
  The medical records of patients undergoing lobectomy by the thoracic surgery service between January 2009 and July 2012 were reviewed. All lobectomies were included irrespective of the etiology of disease. Multivariate logistic regression methods were used to identify predictors of readmission and or early unplanned return to clinic.
  
  
  RESULTS
  Two hundred thirteen patients underwent a pulmonary lobectomy during the study period (median age, 67 years). Pathologic diagnosis was malignant in 94% of the patients and benign in 6%. Minimally invasive approaches were used in 69% of the patients, whereas open thoracotomy was used in 31%. Median hospital length of stay was 4 days, and postoperative mortality occurred in 1 patient (0.5%). The Charlson comorbidity index was 1 ± 1. Predicted postoperative forced expiratory volume in 1 second and diffusing capacity of the lung for carbon monoxide were 68% ± 18% and 64% ± 17%, respectively. Postoperative complications occurred in 31% of patients; 13% required readmission to the hospital within 30 days of discharge or early unplanned return to clinic. Predictors of readmission or early unplanned return to clinic were unplanned transfer to the intensive care unit (odds ratio, 10.4; 95% confidence interval, 1.1 to 103.5; p = 0.04) and Charlson comorbidity index greater than 0 (odds ratio, 1.5; 95% confidence interval, 1.04 to 2.03; p = 0.03). Readmission or early unplanned return to clinic was independent of surgical approach (p = 0.32).
  
  
  CONCLUSIONS
  Patients who require a postoperative transfer to the intensive care unit or with higher Charlson comorbidity index are at higher risk for hospital readmission after pulmonary lobectomy. Readmission was not affected by the surgical approach. Whether a different strategy to follow-up for these high-risk patients can prevent readmission remains to be determined.
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Roland
authors.initials: R
authors.lastname: Assi
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wong
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Zuoheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Chupp
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: anthony.kim@yale.edu.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors