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Date of Graduation

8-2000

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Rob Rosenow, PharmD

Second Advisor

John R. Randy Jr, MD

Abstract

Objectives: Define the prevalence and patterns of hospital readmissions following pulmonary resection.

Methods: Pulmonary resections (pneumonectomy, lobectomy, segementectomy, wedge resection) from a prospectively maintained computerized thoracic surgery database were analyzed over a 5 year period (1/1995-12/1999). Lung biopsies were excluded. Readmissions were defined as In-patient stays or emergency department evaluations within 90 days of surgery. Readmission analysis excluded operative deaths.

Results: 374 patients underwent pulmonary resections. Mean age: 60.1 (range: 14-88). 6 patients died (1.6%). Mean lengths of stay (LOS): 6.5 +/- 4.5 days.

Of 368 patients discharged, 60 patients (18.8%) were readmitted: 69-one time, 27-two times, 11 three-times, 4-four times, and 2-five times, for a total of 113 readmissions. 41 patients (59%) were readmitted as in-patients. Readmission causes: pulmonary (27.4%), surgical sound infection (14.2%), other (15.9%), cardiac (7.1%), gastrointestinal (5.3%), deep venous thrombosis (2.7%), neurologic, psychiatric, urinary (each 0.9%). Mean time to readmission: 32.5 +/- 24.6 days. Readmission mean LOS: 2.9 +/- 3.5 days. Readmissions to hospitals other than where the surgery was performed: 1st - 15.9%, 2nd - 14.8%, 3rd - 36.6%, 4th - 25%, 5th - 0%.

4% (12/299) of patients discharged after pulmonary resection and not requiring readmission died over the 5 years, while 11.6% (8/69) of those requiring readmission died.

Conclusions: Readmission after pulmonary resection is the most frequent postoperative complication. Pulmonary diagnoses and infection due to the thoracic surgery predominate as causes of readmission. Readmissions are frequently multiple. An important portion of readmissions occurs outside the institution performing the surgery. The population requiring readmission after undergoing pulmonary resection is at increased risk of subsequent mortality.

Comments

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