Early Discharge Does Not Increase Rate of Readmission in Thoracic Surgery Patients
Guillaume Chevrollier, Nathaniel Evans III, Thomas Jefferson University, Philadelphia, PA
OBJECTIVE: In an effort to reduce length of stay (LOS) and contain hospital costs, postoperative fast-track pathways have gained popularity. However, the safety of such pathways after thoracic surgery has yet to be clearly demonstrated, and there remains concern for increased risk of readmission. To address this issue, we examined the relationship between LOS and 30-day readmission in patients undergoing lung resection.
METHODS: Using the Society of Thoracic Surgeons (STS) National Database, we selected all patients who underwent lobectomy or segmentectomy between January 2010 and July 2017 at our institution. We focused on patient age, sex, type of surgery, LOS, and 30-day readmission. Readmission rate was calculated and compared between patients with short (1-2 days, n=163), normal (3-5 days, n=154), and long (6+ days, n=66) LOS.
RESULTS: We identified 383 patients, with an average age of 67 years; 162 patients (42.3%) were male. The majority of patients (n=349, 91%) underwent lobectomy. Median LOS for all patients was 3.0 days. Median LOS was significantly shorter for patients undergoing segmentectomy than lobectomy (2.0 vs. 3.0; p=0.02). Overall 30-day readmission rate was 10.4%. Readmission rate was not significantly different in patients with short LOS compared to patients with normal LOS (7.4% vs 13%; P=0.14), nor was it significantly different between patients with short and normal LOS compared to patients with long LOS (10.1% vs 12.1%; P=0.66).
CONCLUSIONS: Patients with early discharge are not at increased risk of readmission after lung resection. Implementation of fast-track protocols should not be limited by concern for readmission.