Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 5, November 2013, Pages 1740-1746
The Annals of Thoracic Surgery

Original article
General thoracic
A Comparison of Length of Stay, Readmission Rate, and Facility Reimbursement After Lobectomy of the Lung

Presented at the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.06.053Get rights and content

Background

Readmission to the hospital has become a focus for payers with the threat of nonpayment for preventable readmissions and a global penalty for excessive readmissions rates. This study compares readmission rates with lengths of stay (LOS) for patients undergoing lobectomy of the lung and the potential impact on reimbursement.

Methods

The Premier database for a single health system's hospitals was used to identify patients undergoing lobectomy for non-small cell lung cancer by cardiothoracic surgeons over a 5-year period. Charlson comorbidity scores were also calculated. Regression analysis was used to study the relationship between length of stay and readmission rates. A comparison of the effects of LOS and readmission on reimbursement was also performed.

Results

During the study period, 4,296 lobectomies were performed in 61 hospitals within the healthcare system that met the study's inclusion criteria. A readmission was recorded for 289 patients (7%). Factors associated with readmission were length of stay less than 5 days or more than 16 days and age more than 78 years (p = 0.001). An analysis of the effects of LOS and readmission on reimbursement found an extension of LOS was more cost effective than a readmission.

Conclusions

This review found that mean LOS after lobectomy is negatively associated with readmission rates, with the maximal effect being before postoperative day 5. Furthermore, facility reimbursement was optimized when LOS was extended to minimize the risk of readmission.

Section snippets

Patients and Methods

Institutional Review Board approval was obtained at the authors' institution, and individual patient consent was not required with the condition of patient anonymity outside the initial data-gathering phase of the study. Using the Premier inpatient database (Premier Inc, Charlotte, NC), hospitals performing at least 50 lobectomies, cumulative (Current Procedural Terminology [CPT] code 32480) for NSCLC (diagnosis codes 162.2, 162.3, 162.4, 162.5, 162; International Classification of Diseases,

Results

Over the 5-year study period, 4,411 lobectomies were performed by 69 cardiothoracic surgeons at 61 hospitals in 31 states that met the entrance criteria for this investigation. Operative mortality occurred in 114 of patients (2.6%) who subsequently had no risk of readmission. Therefore, 4,296 patients undergoing lobectomy were available for analysis.

Readmission to a hospital within 90 of discharge could be documented to have occurred in 367 of these patients. Review of each readmission resulted

Comment

An unplanned or potentially preventable readmission to the hospital within 30 days of discharge has been recognized to occur in as many as one in five Medicare beneficiaries. This is estimated to result in a cost of more than 15 billion dollars per year for CMS. Appropriately, such a figure has drawn attention from CMS and private health care insurers as an area of potential cost saving. Under Medicare's Inpatient Prospective Payment System as included in the Affordable Care Act, excessive

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