In case of emergency, go to your nearest emergency department - Or maybe not?

• Published in: Canadian Journal of Surgery 2021-12, Vol.64, p.S107-S107
• Main Authors: Abbas, M, Olaiya, O, Begum, H, Mbuagbaw, L, Finley, C, Hanna, W, Agzarian, J, Shargall, Y
• Format: Article
• Language: English
• Subjects: Lung cancer; Thoracic surgery
• ISSN: 0008-428X; 1488-2310

Background: Hospital readmission after lung cancer surgery is associated with worsened overall survival. This retrospective cohort study examined whether readmission to the index hospital was associated with improved outcomes in comparison to non-index hospital readmission. Methods: Patients undergoing lung cancer resection between 2012 and 2019 were identified from a prospectively maintained institutional database at a tertiary thoracic centre in Ontario. Patient demographic variables, operative parameters and postoperative complications were recorded. The primary outcomes were readmission rate and number of repeated readmissions across index and non-index hospitals. Overall survival was examined as a secondary outcome and survival differences were examined using a log-rank test. Cox regression identified the association between non-index readmission and all-cause mortality. Logistic regression analyzed factors associated with readmissions at 90 days postoperatively. Results: Over the study period, 3615 patients were identified, of whom 311 (9%) required readmission, with 173 of those (56%) being readmitted to the index hospital. Older patients were more likely to be admitted to non-index hospitals (p = 0.018), and patients presenting to non-index hospitals were more likely to require multiple readmissions than patients presenting to the index hospital (odds ratio 2.0, 95% confidence interval [CI] 1.1-3.6, p = 0.024). Importantly, patients readmitted to non-index hospitals had a worse overall survival (adjusted hazard ratio 1.9, 95% CI 1.2-2.9, p = 0.006). Conclusion: This study found that non-index hospital readmission after lung cancer resection is associated with an increased risk of multiple readmission and a decreased overall survival. These results highlight the importance of close clinical follow-up in patients after thoracic surgery and emphasize the expertise and specialization required in their postoperative care.