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J Surg Res. 2018 Oct;230:117-124. doi: 10.1016/j.jss.2018.04.065. Epub 2018 May 25.

Thirty-day unplanned postoperative inpatient and emergency department visits following thoracotomy.

Author information

1
Stanford University School of Medicine, Stanford, California.
2
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
3
Department of Surgery, Palo Alto VA, Palo Alto, California.
4
Department of Surgery, Palo Alto VA, Palo Alto, California; Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: boussard@stanford.edu.

Abstract

BACKGROUND:

Unplanned visits to the emergency department (ED) and inpatient setting are expensive and associated with poor outcomes in thoracic surgery. We assessed 30-d postoperative ED visits and inpatient readmissions following thoracotomy, a high morbidity procedure.

MATERIALS AND METHODS:

We retrospectively analyzed inpatient and ED administrative data from California, Florida, and New York, 2010-2011. "Return to care" was defined as readmission to inpatient facility or ED within 30 d of discharge. Factors associated with return to care were analyzed via multivariable logistic regressions with a fixed effect for hospital variability.

RESULTS:

Of 30,154 thoracotomies, 6.3% were admitted to the ED and 10.2% to the inpatient setting within 30 d of discharge. Increased risk of inpatient readmission was associated with Medicare (odds ratio [OR] 1.30; P < 0.001) and Medicaid (OR 1.31; P < 0.0001) insurance status compared to private insurance and black race (OR 1.18; P = 0.02) compared to white race. Lung cancer diagnosis (OR 0.83; P < 0.001) and higher median income (OR 0.89; P = 0.04) were associated with decreased risk of inpatient readmission. Postoperative ED visits were associated with Medicare (OR 1.24; P < 0.001) and Medicaid insurance status (OR 1.59; P < 0.001) compared to private insurance and Hispanic race (OR 1.19; P = 0.04) compared to white race.

CONCLUSIONS:

Following thoracotomy, postoperative ED visits and inpatient readmissions are common. Patients with public insurance were at high risk for readmission, while patients with underlying lung cancer diagnosis had a lower readmission risk. Emphasizing postoperative management in at-risk populations could improve health outcomes and reduce unplanned returns to care.

KEYWORDS:

Lung cancer; Readmissions; Thoracotomy

PMID:
30100026
PMCID:
PMC6732253
DOI:
10.1016/j.jss.2018.04.065
[Indexed for MEDLINE]
Free PMC Article

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