Hospital readmission after pulmonary resection: Prevalence, patterns, and predisposing characteristics

Background. Our objective was to define the prevalence, patterns, and predi sposing characteristics for hospital readmission after pulmonary resection. Methods. Five years of pulmonary resections, excluding lung biopsies, were analyzed from a prospective, computerized database. Readmission was defined as inpatient or emergency department admission within 90 days of operation . Search of 1,173,912 admissions to the Providence Health System in Oregon identified readmissions. Readmission analysis excluded operative deaths. Results. A total of 374 patients underwent pulmonary resections, of whom 8 died (2.1%). Of 366 patients discharged, 69 (18.9%) were readmitted a total of 113 times: 42 had only one readmission, 16 had two readmissions, 7 had three readmissions, 2 had four readmissions, and 2 had five readmissions. S lightly more than half (51%) were readmitted as inpatients. Causes of the 1 13 readmissions included pulmonary (27%), postoperative infection (14%), ca rdiac (7%), and other (16%). Mean time to readmission was 32.5 +/- 24.6 day s. Inpatient readmission mean length of stay was 4.9 +/- 3.4 days. Readmiss ion to hospitals other than the hospital of the operation was as follows: f irst readmission, 15.9%; second readmission, 14.8%; third readmission, 36.3 %; fourth readmission, 25%; fifth readmission, 0%. Analysis revealed only p neumonectomy as a risk for readmission. Twelve of 33 (36%) pneumonectomies were readmitted (p = 0.005). Of the 297 patients discharged after pulmonary resection and not requiring readmission, 12 (4%) died over the study inter val, whereas 8 of 69 patients (11.6%) requiring readmission died. Conclusions. Readmission after pulmonary resection is frequent and multiple readmissions are common. Causes are predominately pulmonary diagnoses and infections related to the operation. Pneumonectomy is a risk for readmissio n. An important portion of readmissions occurs outside the hospital of oper ation. The population requiring readmission after successfully undergoing p ulmonary resection is at increased risk of subsequent mortality. (C) 2001 b y The Society of Thoracic Surgeons.