Readmission Risk After Operative Management of Empyema
Raymond A. Jean1, *Alexander S. Chiu1, *Daniel J. Boffa1, Anthony W. Kim2, *Frank C. Detterbeck1, *Justin D. Blasberg1
1Yale School of Medicine, New Haven, CT; 2Keck School of Medicine at USC, Los Angeles, CA
Objective: To investigate the impact of operative management for pleural empyema in a large national dataset. Design: Retrospective cohort
Setting: Patients admitted in the United States between 2013 and 2014.
Patients: The Nationwide Readmissions Database (NRD) was examined for patients with a primary diagnosis of empyema receiving primary operative or nonoperative management.
Main Outcome Measures: Patients surviving were followed for non-elective readmission during the 90-day period after discharge.
Results: A total of 5,994 discharges for empyema were identified during the study period, of which 2,482 (41.4%) were managed operatively and 3,512 (58.6%) were managed non-operatively. Non-operative patients were older (mean age 62.7 vs 56.5 years, p<0.0001) and more frequently had 2 or more comorbidities (46.9% vs 28.9%, p<0.0001) than operative patients. Non-operative discharges had a mean length of stay of 7.9 days, in comparison to 10.3 days for operative discharges (p<0.0001). Overall, 24.6% of non-operative patients were readmitted urgently or emergently within 90-days, in comparison to 14.1% of operative patients (p<0.0001). Although operative hospitalizations were more costly than non-operative (non-operative $15,649 vs operative $25,361, p<0.0001), readmissions after an operative admission were significantly less costly (non-operative $18,395 vs operative ,358, p=0.003).
Conclusions: Patients managed operatively for empyema had a significantly lower rate of non-elective readmission during the 90-day period after index hospitalization. Although operative management was approximately $10,000 more costly during the index hospitalization, readmitted patients had significantly less costly readmissions.