Skip to main content
Log in

Factors Associated with Unexpected Readmission Following Lung Resection

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

A Correction to this article was published on 16 February 2021

This article has been updated

Abstract

Background

Identification of the predictors of readmission can facilitate appropriate perioperative management. The current study aimed to investigate the potential predictors of unexpected readmission after lung resection for primary lung cancers.

Methods

This retrospective study enrolled 1000 patients who underwent pulmonary resection for lung cancer at our institution between January 2016 and December 2017. Unexpected readmission was defined as unscheduled readmission to our hospital within 30 days after discharge. Univariate and multivariate analyses were performed for identification of perioperative factors associated with readmission.

Results

Forty-three patients (4.3%) required unexpected readmission, and the median interval between the day of discharge and readmission was 10 days (range 1–29 days). The reasons for readmission included empyema and pleural effusion (n = 11), acute exacerbation of idiopathic pulmonary fibrosis (n = 7), pneumothorax (n = 7), and others (n = 18). The median hospitalization length after readmission was 14 days (range 2–90 days). Four patients (9.3%) died in the hospital because of acute exacerbation of idiopathic pulmonary fibrosis after readmission. In multivariate logistic regression analysis, postoperative refractory air leakage, defined as prolonged air leakage lasting > 5 days or requiring reoperation, was identified as a significant predictor associated with an increased risk of readmission (odds ratio 2.87; 95% confidence interval 1.22–6.72; p = 0.015).

Conclusions

Unexpected readmission was an inevitable event following lung resection. Patients with readmission had an increased risk of death. Refractory air leakage after lung resection for primary lung cancer was strongly associated with unexpected readmission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

References

  1. Tsai TC, Joynt KE, Orav EJ et al (2013) Variation in surgical readmission rates and quality of hospital care. N Engl J Med 369:1134–1142

    Article  CAS  Google Scholar 

  2. Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360:1418–1428

    Article  CAS  Google Scholar 

  3. Lucas DJ, Haider A, Haut E et al (2013) Assessing readmission after general, vascular and thoracic surgery using ACS-NSQIP. Ann Surg 258:430–439

    Article  Google Scholar 

  4. Allen MS, Blackmon SH, Nichols FC III et al (2015) Comparison of two national databases for general thoracic surgery. Ann Thorac Surg 100:1155–1162

    Article  Google Scholar 

  5. Hu Y, McMurry TL, Isbell JM et al (2014) Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality. J Thorac Cardiovasc Surg 148:2261–2267

    Article  Google Scholar 

  6. Puri V, Patel AP, Crabtree TD et al (2015) Unexpected readmission after lung cancer surgery: A benign event? J Thorac Cardiovasc Surg 150:1496–1505

    Article  Google Scholar 

  7. Bhagat R, Bronsert MR, Ward AN et al (2017) National analysis of unplanned readmission after thoracoscopic versus open lung cancer resection. Ann Thorac Surg 104:1782–1790

    Article  Google Scholar 

  8. Dickinson KJ, Taswell JB, Allen MS et al (2017) Unplanned readmission after lung resection: complete follow-up in a 1-year cohort with identification of associated risk factors. Ann Thorac Surg 103:1084–1091

    Article  Google Scholar 

  9. Quero-Valenzuela F, Piedra-Fernández I, Martínez-Ceres M et al (2018) Predictors for 30-day readmission after pulmonary resection for lung cancer. J Surg Oncol 117:1239–1245

    Article  Google Scholar 

  10. Endo S, Ikeda N, Kondo T et al (2017) Model of lung cancer surgery risk derived from a Japanese nationwide web-based database of 78594 patients during 2014–2015. Eur J Cardiothorac Surg 52:1182–1189

    Article  Google Scholar 

  11. Asamura H (2008) Minimally invasive open surgery approach for the surgical resection of thoracic malignancies. Thorac Surg Clin 18:269–273

    Article  Google Scholar 

  12. Katayama H, Kurokawa Y, Nakamura K et al (2016) Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46:668–685

    Article  Google Scholar 

  13. Fernandez FG, Falcoz PE, Kozower BD et al (2015) The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: joint standardization of variable definitions and terminology. Ann Thorac Surg 99:368–376

    Article  Google Scholar 

  14. Raghu G, Collard HR, Egan JJ et al (2011) An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 183:788–824

    Article  Google Scholar 

  15. How CH, Tsai TM, Kuo SW et al (2014) Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax. J Formos Med Assoc 113:284–290

    Article  CAS  Google Scholar 

  16. Yokomise H, Satoh K, Ohno N et al (1998) Autoblood plus OK432 pleurodesis with open drainage for persistent air leak after lobectomy. Ann Thorac Surg 65:563–565

    Article  CAS  Google Scholar 

  17. Freeman RK, Dilts JR, Ascioti AJ et al (2013) A comparison of length of stay, readmission rate, and facility reimbursement after lobectomy of the lung. Ann Thorac Surg 96:1740–1746

    Article  Google Scholar 

  18. Konstantinidis K, Woodcock-Shaw J, Dinesh P et al (2018) Incidence and risk factors for 90-day hospital readmission following video-assisted thoracoscopic anatomical lung resection. Eur J Cardiothorac Surg 55:666–672

    Article  Google Scholar 

  19. Assi R, Wong DJ, Boffa DJ et al (2015) Hospital readmission after pulmonary lobectomy is not affected by surgical approach. Ann Thorac Surg 99:393–398

    Article  Google Scholar 

  20. Rosen JE, Salazar MC, Dharmarajan K et al (2017) Length of stay from hospital perspective practice of early discharge is not associated with increased readmission risk after lung cancer surgery. Ann Surg 266:383–388

    Article  Google Scholar 

  21. Rajaram R, Ju MH, Bilimoria KY et al (2015) National evaluation of hospital readmission after pulmonary resection. J Thorac Cardiovasc Surg 150:1508–1514

    Article  Google Scholar 

  22. Varela G, Aranda JL, Jiménez MF et al (2004) Emergency hospital readmission after major lung resection: prevalence and related variables. Eur J Cardiothorac Surg 26:494–497

    Article  Google Scholar 

  23. McDevitt J, Kelly M, Comber H et al (2013) Population-based study of hospital length of stay and emergency readmission following surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg 44:e253-259

    Article  Google Scholar 

  24. Stiles BM, Poon A, Giambrone GP et al (2016) Incidence and factors associated with hospital readmission after pulmonary lobectomy. Ann Thorac Surg 101:434–442

    Article  Google Scholar 

  25. Medbery RL, Gillespie TW, Liu Y et al (2016) Socioeconomic factors are associated with readmission after lobectomy for early stage lung cancer. Ann Thorac Surg 102:1660–1667

    Article  Google Scholar 

  26. Varela G, Jiménez MF, Novoa N et al (2005) Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 27:329–333

    Article  Google Scholar 

  27. Gilbert S, Maghera S, Seely AJ et al (2016) Identifying patients at higher risk of prolonged air leak after lung resection. Ann Thorac Surg 102:1674–1679

    Article  Google Scholar 

  28. Ogawa F, Satoh Y, Iyoda A et al (2015) Clinical impact of lung age on postoperative readmission in non-small cell lung cancer. J Surg Res 193:442–448

    Article  Google Scholar 

  29. Temes RT, Willms CD, Endara SA et al (1998) Fissureless lobectomy. Ann Thorac Surg 65:282–284

    Article  CAS  Google Scholar 

  30. Malapert G, Hanna HA, Pages PB et al (2010) Surgical sealant for the prevention of prolonged air leak after lung resection: meta-analysis. Ann Thorac Surg 90:1779–1785

    Article  Google Scholar 

Download references

Acknowledgements

Authors acknowledge the Biostatistics division, center for research and administration and support, National Cancer Center.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shun-ichi Watanabe.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Some of the entries in Table 3 appeared in the wrong column.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uchida, S., Yoshida, Y., Yotsukura, M. et al. Factors Associated with Unexpected Readmission Following Lung Resection. World J Surg 45, 1575–1582 (2021). https://doi.org/10.1007/s00268-020-05942-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05942-z

Navigation