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

Shaffer R, Backhus L, Finnegan MA, Remington AC, Kwong JZ, Curtin C, Hernandez-Boussard T. Thirty-day unplanned postoperative inpatient and emergency department visits following thoracotomy. The Journal of surgical research. 2018 Oct 1; 230:117-124.

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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.