Readmissions after Lobectomy in an Era of Increasing Minimally Invasive Surgery: A Statewide Analysis
Brandon S. Hendriksen, Michael F. Reed, Matthew D. Taylor, Christopher S. Hollenbeak, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
OBJECTIVE: Utilization of minimally invasive surgical modalities for lobectomy is increasing. Lobectomy can be associated with high rates of readmission. As use of these modalities increases, evaluation of the impact on readmission is warranted. We hypothesized that minimally invasive lobectomy would be associated with lower rates of readmission.
METHODS: Data from the Pennsylvania Health Care Cost Containment Council (PHC4) were used to identify lobectomy operations performed in Pennsylvania from 2011 through 2014. Each operation was categorized by approach: open, video-assisted thoracoscopic surgery (VATS), or robotic. Differences in patient characteristics were assessed with t-tests and ANOVA. Logistic regression modeled risk of 30-day readmission and linear regression modeled length of stay (LOS) after controlling for confounders.
RESULTS: We evaluated 4,939 lobectomy operations (2,501 open, 1,944 VATS, 494 robotic) with 583 readmissions (11.8%). Robotic cases increased 333% over 4 years. VATS and open cases increased 38% and 22%, respectively. Surgical approach did not affect hospital readmission (VATS Odds Ratio (OR) = 0.95 p= 0.6320 and robotic OR=1.02 p=0.9160). Longer LOS was associated with a greater likelihood of readmission (OR=1.58 p=0.0020). LOS was 1 day less for VATS (p<0.0001) and 1.5 days less for robotic lobectomy (p< 0.0001) when compared to an open approach. The most common reasons for readmission were respiratory disease and non-respiratory infection and are illustrated in Figure 1.
CONCLUSIONS: Surgical approach does not directly affect readmission. Indeed, the greater utilization of minimally invasive lobectomy, and the resultant decreased LOS, is not causing higher rates of readmission.
Figure 1 – Reasons for Readmission after Lobectomy