Hospital Readmission after Major Pulmonary Resection for Lung Cancer in France: A Nationwide Medico-Administrative Database

Abstract

Objectives: After major pulmonary resection for lung cancer, hospital readmission is considered an indicator of the quality of care. Our main objective was to define the readmission rate at 30 days after pulmonary resection. Secondary objectives were to determine the causes and predictive factors. Methods: Data for all patients operated for lung cancer were extracted from the national medico-administrative database of the Programme de Medicalisation des Systemes d'Information (PMSI). Thirty-days hospital readmission was defined as any new hospitalization within 30 days after discharge from the surgical department following major lung resection, regardless of the reason for readmission. Results: From January 1st, 2008 to December 31st, 2016, 68,575 patients were operated for lung cancer in France. The all-cause readmission rate was 23.6% (n=16214). Overall, 3,695 patients were readmitted for a complication (5.4%) and 12,519 were readmitted for other causes (18%). The main complications were surgical complications (n=1778, 44%), pneumopathy (n=574, 14%), respiratory failure (n=426, 11%), cardiovascular disease (n=372, 9%), malnutrition (n=329, 8%) and bleeding (n=131, 3%). Patients operated on in a teaching hospital and discharged to another establishment had an adjusted odds ratio (AOR) of 0.73 (95% Confidence Interval (CI) 0.58-0.92; p<0.008). The type of pulmonary resections and the approach had a significant influence on the occurrence of hospital readmission. An initial length of stay of more than 14 days resulted in an AOR of 1.4 (95% CI 1.3-1.54) (p<0.0001). The occurrence of sepsis during the 1st hospitalization is significantly related to a readmission with an AOR of 0.89 (95CI 0.83-0.97) (p<0.005). Conclusion: The rate of hospital readmission after major pulmonary resection for lung cancer in France was 23.6%. This work demonstrates the need to implement measures to reduce readmission after surgery. Funding Statement: The author(s) received no specific funding for this work. Declaration of Interest: The authors have no disclosure to declare for this work. Ethical Approval Statement: Ethics approval for use of this database was obtained from the National Commission for Data protection (CNIL No 1576793), and this study adhered to the tenets of the declaration of Helsinki.