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Patient Disposition After Lobectomy For Lung Cancer Predicts Hospital Readmission
*Brian N Arnold, *Matthew R. DeLuzio, *Daniel C. Thomas, *Michelle C. Salazar, *Joshua E. Rosen, *Frank C. Detterbeck, *Justin D. Blasberg, *Daniel J. Boffa, Anthony W. Kim
Yale School of Medicine, New Haven, CT

Objective: To study the impact of discharge disposition and its effects on readmission following lobectomy for lung cancer. Design: IRB-approved single institution case-control study of lung cancer patients who underwent lobectomy from 2008-2014. Setting: Tertiary care academic medical center. Patients: All lung cancer patients who underwent lobectomy by board-certified thoracic surgeons who were living at home before surgery and discharged alive. Interventions: Univariate and multivariate modeling of 72 patient factors on 90-day readmission and discharge disposition. Bootstrap techniques used to internally validate models. Main Outcome Measures: 90-day unplanned readmission and discharge disposition from index operation (home vs. facility). Results: 379 patients met inclusion criteria. The overall readmission rate was 11.6%. Prognostic factors for readmission on multivariate analysis were low preoperative hemoglobin (OR 3.18, p=0.0011), prior lobectomy (OR 3.69, p=0.0283), prior MI (OR 3.05, p=0.0379), and discharge to facility (OR 3.03, p=0.0072). Bootstrap analysis also identified perioperative ventilator use >48hrs to be predictive of readmission (53.2%). Overall, 13.2% of patients were discharged to a facility. Prognostic factors for discharge to facility were age ≥80 (OR 4.80, p=0.0014), ICU stay (OR 3.46, p=0.0015), and UTI prior to discharge (OR 2.84, p=0.0424). Bootstrap analysis additionally identified ASA class 4 (50.7%) and history of diabetes (52.1%) as predictors. Bootstrap analysis excluded age 70-79 (44.9%) and antileukotriene use (49.0%) which were present in the initial model. Reason for readmission was not different between home and facility discharges. Conclusions: Discharge to a facility is a significant predictor of 90-day unplanned readmission in patients undergoing lobectomy for lung cancer. Efforts to improve readmission rates should focus on close follow up of patients discharged to a facility.

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