Delayed discharge does not decrease the cost of readmission after pulmonary lobectomy

Background: Readmission after pulmonary lobectomy has become a potentially avoidable source of excess health care costs. Initiatives that focus on expedited discharge after lobectomy may decrease costs, but a criticism of this approach is that expedited discharge may be associated with more frequent and more expensive readmissions. We explored whether patients are at greater risk for costly readmission after expedited discharge.

Methods: The Nationwide Readmission Database was queried for cases of lobectomy for lung cancer between 2010 and 2014. Patients 65 years of age and older were categorized into three groups: patients discharged between hospital day 1 and 3 (expedited), between hospital days 4 and 7 (routine), or discharge after day 8 (late). Risk-adjusted 90-day readmission rates and hospital costs for readmission were compared among groups.

Results: A total of 104,905 patients underwent lobectomy for lung cancer during the study period. There were 18,652 (17.8%) expedited discharges, 54,551 (52.0%) routine discharges, and 31,702 (30.2%) late discharges. Compared with the expedited group, patients in the routine discharge group had a 3.2% greater risk-adjusted readmission rate (P < .0001), and patients in the late discharge group had 12.7% greater risk-adjusted readmission rate (P < .0001). After adjustment, expedited discharge was associated with a $4,066 decrease in index hospital costs compared with routine discharge, and a $19,233 decrease compared with late discharges (both P < .0001) but was not associated with costlier readmission (routine mean -$24 ± standard error $153, P = .87; late mean +$2,528 ± standard error $178; P < .0001).

Conclusion: Expedited discharge after lobectomy is associated with a greater risk-adjusted readmission rate and greater index hospital costs over routine and late discharge, with no increased costs for readmission. These data demonstrate that prolonged hospital duration of stay does not decrease the risk of 90-day readmission after lobectomy, providing support for protocols that expedite patient discharge and decrease overall health care utilization.