title: Unplanned Readmission After Lung Resection: Complete Follow-Up in a 1-Year Cohort With Identification of Associated Risk Factors.
abstract: BACKGROUND
  Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors.
  
  
  METHODS
  All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service. Demographic data were supplemented from our prospectively maintained database. Follow-up was complete in 100% of patients.
  
  
  RESULTS
  Over the 12-month study period, 582 lung resections were performed. Five hundred fifty-four resections in 532 patients were performed with the thoracic surgical service as the primary service. Of these patients, 505 undergoing 521 resections consented for their data to be included in the study, and they all survived to 30 days. Mean age was 62.3 years (standard deviation [SD], 13.8 years). The male to female ratio was 265:240. Fifteen pneumonectomies, 222 lesser anatomic resections in 215 patients, and 270 nonanatomic (wedge) resections in 261 patients were performed; 14 other miscellaneous resections were performed in 14 patients. Thirty-day mortality was 1% (5 of 510 patients). There were 4 in-hospital deaths and 1 additional mortality within 30 days. Unplanned readmissions occurred in 42 patients (42 of 505 patients [8.3%])-28 (67%) at our institution and 14 (33%) at other institutions. The median interval to readmission was 14 days. Readmissions occurred in 7.3% of patients discharged home, whereas 19.4% of patients discharged to a nursing home or other facility required readmission (p = 0.041). The most common reason for readmission was respiratory complications (47%). Significant factors (p < 0.05) associated with increased risk of readmission were lower percent predicted forced expiratory volume in 1 second (FEV1), longer operative time, perioperative furosemide administration, pain score of 6 or greater between 12 and 24 hours after the operation, prolonged air leakage (>5 days), blood transfusion, and discharge to a nursing home. Length of stay after lung resection was not a risk factor for unplanned readmission.
  
  
  CONCLUSIONS
  The unplanned readmission rate after lung resection for our cohort was 8.3%, with half resulting from respiratory issues. Risk factors in the preoperative, perioperative, and postoperative setting were identified that may provide opportunities for mitigating these adverse events.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Dickinson
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: James B
authors.initials: JB
authors.lastname: Taswell
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shanda H
authors.initials: SH
authors.lastname: Blackmon
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Shen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: cassivi.stephen@mayo.edu.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
mesh_terms: D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011013:Pneumonectomy; D011183:Postoperative Complications; D012307:Risk Factors