Jean et al evaluated patients undergoing pulmonary lobectomy for the risk of readmission. They identified the impact of comorbidities and postoperative complications on readmissions. The authors are from Yale University and the University of California at Los Angeles.
Patient selection: pulmonary lobectomy for lung cancer
Outcome: all-cause readmission within 90 days
Parameters:
(1) number of comorbidities based on Elixhauser classification
(2) number of postoperative complications
Complications included:
(1) cardiac arrhythmia (supraventricular tachycardia, atrial fibrillation)
(2) acute myocardial infarction
(3) stroke
(4) deep vein thrombosis
(5) pulmonary embolism
(6) pneumonia and empyema
(7) acute respiratory failure
(8) sepsis
(9) urinary tract infection
(10) surgical site infection
Number of Comorbidities
|
Number of Complications
|
Risk Adjusted Readmission Rate
|
0
|
0
|
11.7%
|
0
|
1
|
12.1%
|
0
|
2
|
12.6%
|
0
|
3+
|
12.7%
|
1
|
0
|
13.7%
|
1
|
1
|
14.0%
|
1
|
2
|
14.4%
|
1
|
3+
|
14.5%
|
2
|
0
|
16.0%
|
2
|
1
|
16.7%
|
2
|
2
|
16.8%
|
2
|
3+
|
17.1%
|
3+
|
0
|
21.0%
|
3+
|
1
|
21.6%
|
3+
|
2
|
21.7%
|
3+
|
3+
|
22.1%
|
where:
• The increase in risk between 0 complications and 3+ is only about 1%.
• The presence of categories for 0 comorbidities suggests that lung cancer was not counted as a comorbidity.
Interpretation offered:
(1) A patient with multiple comorbid conditions may be readmitted for a chronic condition.
(2) Avoiding postoperative complications may reduce readmissions.
(3) A patient without comorbid conditions and complications has a significant readmission rate.