Incidence and risk factors for 90-day hospital readmission following video-assisted thoracoscopic anatomical lung resection†.

Abstract

The objective of this study was to identify risk factors for 90-day hospital readmission after video-assisted thoracoscopic surgery (VATS) anatomical lung resections. This study is a retrospective analysis of data collected from 481 patients discharged after VATS lobectomy or segmentectomy (January 2012-February 2016). Univariable and stepwise logistic regression analyses were used to identify risk factors for hospital readmission. Hospital readmissions occurred in 59 patients (12.3%). Twenty-three (39%) of them were readmitted after the first 30 days following operation. A short hospital stay (<3 days) was associated with only 3.6% readmission, while 21% of patients with a hospital stay longer than 7 days were readmitted. The most frequent cause of readmission was pneumonia in 17 patients accounting for 26% of all readmissions. Eighteen patients were readmitted for problems related to prolonged chest drain management. Readmission for chest pain occurred in six patients in this VATS population. One hundred and one patients experienced prolonged air leak. Their readmission rate was 21% vs 11% in patients without prolonged air leak (P < 0.0001). The 90-day mortality rate after the initial discharge was similar in readmitted and non-readmitted patients (0 vs 1.2%, Fisher's exact test, P = 1). Stepwise logistic regression analysis showed that the only patient-related factor independently associated with readmission was low body mass index (<18.5 kg/m2) (P < 0.0001). Readmissions after VATS anatomical lung resections are not uncommon. More than one-third of readmissions occur between 30 days and 90 days from the index operation. Patients should be counselled about the risk of readmission to set realistic expectations of the surgical procedure.