A population-based study of hospital length of stay and emergency readmission following surgery for non-small-cell lung cancer

OBJECTIVES We conducted a population-based analysis of time trends in length of stay (LOS), predictors of prolonged LOS and emergency readmission following resection for non-small-cell lung cancer (NSCLC). METHODS Incident lung cancers (ICDO2:C34), diagnosed between 2002 and 2008, were identified from the National Cancer Registry (NCR) of Ireland, and linked to hospital in-patient episodes (HIPE). For those with NSCLC who underwent lung resection, the associated hospital episode was identified. Factors predicting longer LOS (upper quartile, >20 days), and emergency readmission within 28 days of the index procedure (IP) were investigated using Poisson regression. RESULTS A total of 1284 patients underwent resection. Eighty-four (7%) subsequently died in hospital and 1200 (93%) were discharged. Hundred and nineteen of 1200 (10%) were readmitted as an emergency within 28 days of discharge. Median LOS after the IP was 13 days (inter-decile range: 7-35). Risk of prolonged LOS was significantly greater in patients >75 years, resident in an area of highest deprivation, with 2+ comorbidities, who had undergone surgery in a lower-volume hospital, and died in hospital subsequent to the IP. Emergency readmission was significantly more likely in patients who were resident in an area of highest deprivation, with 2+ comorbidities, and had Stage III disease or worse. The main reasons for emergency readmission were: pulmonary complications (29%), cardio/cerebrovascular events (21%) or infection (20%). CONCLUSIONS Half of the patients had a LOS in excess of 13 days, which was longer than any other country with published data. Patient and health-service factors were associated with prolonged LOS, while patient and tumour characteristics were associated with risk of emergency readmission. Deprivation was a conspicuous determinant of both LOS and readmission.