title: National evaluation of hospital readmission after pulmonary resection.
abstract: OBJECTIVE
  Our objectives were to (1) assess readmission rates and timing after pulmonary resection, (2) report the most common reasons for rehospitalization, and (3) identify risk factors for unplanned readmission after pulmonary resection.
  
  
  METHODS
  Patients who underwent pulmonary resection were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. We examined readmission within 30 days of surgery for all resections and 3 subgroups: open lobectomy, video-assisted thoracoscopic lobectomy, and pneumonectomy. Regression models were developed to identify factors associated with readmission.
  
  
  RESULTS
  In 1847 patients, there were 899 open lobectomies (49%), 724 video-assisted thoracoscopic lobectomies (39%), and 85 pneumonectomies (5%). The overall readmission rate was 9.3% with no significant difference found among patients undergoing open lobectomy (9.1%), video-assisted thoracoscopic lobectomy (8.4%), or pneumonectomy (11.8%) (P = .576). The median time from operation to readmission was similar among patients undergoing open (14 days) or video-assisted thoracoscopic lobectomy (13 days). The most common cause of readmission for all groups examined was pulmonary related. In multivariable analyses, the strongest factor associated with readmission was an inpatient complication after the initial surgery in all resections (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.05-6.04), open lobectomy (HR, 4.36; 95% CI, 2.75-6.94), and video-assisted thoracoscopic lobectomy (HR, 4.60; 95% CI, 2.65-7.97). Surgical approach was not associated with readmission (video-assisted thoracoscopic vs open lobectomy: HR, 1.07; 95% CI, 0.75-1.52).
  
  
  CONCLUSIONS
  Experiencing a postoperative complication was strongly associated with unplanned readmission. Increased attention toward reducing postoperative complications and earlier outpatient follow-up in these patients may be a viable strategy for decreasing readmissions after pulmonary resection.
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Ill; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Ill. Electronic address: Ravi-Rajaram@fsm.northwestern.edu.
authors.forename: Ravi
authors.initials: R
authors.lastname: Rajaram
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Ill; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Ill.
authors.forename: Mila H
authors.initials: MH
authors.lastname: Ju
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Ill; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Ill.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Ill; Department of Surgery, University of California, Los Angeles and VA Greater Los Angeles Healthcare System, Los Angeles, Calif.
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Ill.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Centers for Medicare and Medicaid Services; Patient readmission; health care; pneumonectomy; postoperative complications; pulmonary surgical procedures; quality indicators; risk factors; thoracic surgery; video-assisted