title: Socioeconomic Factors Are Associated With Readmission After Lobectomy for Early Stage Lung Cancer.
abstract: BACKGROUND
  Data regarding risk factors for readmissions after surgical resection for lung cancer are limited and largely focus on postoperative outcomes, including complications and hospital length of stay. The current study aims to identify preoperative risk factors for postoperative readmission in early stage lung cancer patients.
  
  
  METHODS
  The National Cancer Data Base was queried for all early stage lung cancer patients with clinical stage T2N0M0 or less who underwent lobectomy in 2010 and 2011. Patients with unplanned readmission within 30 days of hospital discharge were identified. Univariate analysis was utilized to identify preoperative differences between readmitted and not readmitted cohorts; multivariable logistic regression was used to identify risk factors resulting in readmission.
  
  
  RESULTS
  In all, 840 of 19,711 patients (4.3%) were readmitted postoperatively. Male patients were more likely to be readmitted than female patients (4.9% versus 3.8%, p < 0.001), as were patients who received surgery at a nonacademic rather than an academic facility (4.6% versus 3.6%; p = 0.001) and had underlying medical comorbidities (Charlson/Deyo score 1+ versus 0; 4.8% versus 3.7%; p < 0.001). Readmitted patients had a longer median hospital length of stay (6 days versus 5; p < 0.001) and were more likely to have undergone a minimally invasive approach (5.1% video-assisted thoracic surgery versus 3.9% open; p < 0.001). In addition to those variables, multivariable logistic regression analysis identified that median household income level, insurance status (government versus private), and geographic residence (metropolitan versus urban versus rural) had significant influence on readmission.
  
  
  CONCLUSIONS
  The socioeconomic factors identified significantly influence hospital readmission and should be considered during preoperative and postoperative discharge planning for patients with early stage lung cancer.
authors.affiliation: Section of General Thoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Medbery
authors.affiliation: Division of Surgical Oncology, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gillespie
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia; Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Dana C
authors.initials: DC
authors.lastname: Nickleach
authors.affiliation: Division of Surgical Oncology, School of Medicine, Emory University, Atlanta, Georgia; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: Section of General Thoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Manu S
authors.initials: MS
authors.lastname: Sancheti
authors.affiliation: Section of General Thoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Allan
authors.initials: A
authors.lastname: Pickens
authors.affiliation: Section of General Thoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.affiliation: Section of General Thoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia. Electronic address: felix.fernandez@emoryhealthcare.org.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics* / Q000639:trends; D011013:Pneumonectomy; D011184:Postoperative Period; D012189:Retrospective Studies; D012959:Socioeconomic Factors