A comparison of length of stay, readmission rate, and facility reimbursement after lobectomy of the lung.

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.

A comparison of quality and cost indicators by surgical specialty for lobectomy of the lung.

OBJECTIVES: This investigation compared patients undergoing lobectomy for non-small cell lung cancer by either a general surgeon or a cardiothoracic surgeon across a geographically diverse system of hospitals to see whether a significant difference in quality or cost was present. METHODS: The Premiere administrative database and tumor registry data of a single health system's hospitals was used to compare adherence to national treatment guidelines, patient outcomes, and charges for patients undergoing lobectomy for non-small cell lung cancer in a 5-year period. Surgeons performing lobectomy were designated as a general surgeon or cardiothoracic surgeon according to their national provider number and board certification status. Excluded from analysis were centers that performed fewer than 50 lobectomies during the study period. RESULTS: During the study period, 2823 lobectomies were performed by 46 general surgeons and 3653 lobectomies were performed by 29 cardiothoracic surgeons in 54 hospitals in a single health care system. Significant differences were found between general and cardiothoracic surgeons with respect to adherence to national guidelines in staging and treatment, mean length of stay, significant morbidity, and operative mortality. Mean charges for lobectomy of the lung were also found to differ significantly between general and cardiothoracic surgeons. CONCLUSIONS: This review found that currently measurable indicators for quality of care were significantly superior and overall charges were significantly reduced when a lobectomy for non-small cell lung cancer was performed by a cardiothoracic surgeon rather than by a general surgeon.