Risk Factors for Return to the Emergency Department and Readmission in Patients With Hospital-Diagnosed Advanced Lung Cancer

Med Care. 2023 Apr 1;61(4):237-246. doi: 10.1097/MLR.0000000000001829. Epub 2023 Feb 3.


Background: Advanced lung cancer (ALC) is a symptomatic disease often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve care delivery.

Objectives: We examined the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed ALC.

Research design, subjects, and measures: In Surveillance, Epidemiology, and End Results-Medicare, we identified patients with incident ALC (stage IIIB-IV small cell or non-small cell) from 2007 to 2013 and an index hospitalization within 7 days of diagnosis. We used a time-to-event model with multivariable regression to identify risk factors for 30-day acute care utilization (emergency department use or readmission).

Results: More than half of incident ALC patients were hospitalized around the time of diagnosis. Among 25,627 patients with hospital-diagnosed ALC who survived to discharge, only 37% ever received systemic cancer treatment. Within 6 months, 53% had been readmitted, 50% had enrolled in hospice, and 70% had died. The 30-day acute care utilization was 38%.Small cell histology, greater comorbidity, precancer acute care use, length of index stay >8 days, and prescription of a wheelchair were associated with higher risk of 30-day acute care utilization. Age >85 years, female sex, residence in South or West regions, palliative care consultation, and discharge to hospice or a facility were associated with lower risk.

Conclusions: Many patients with hospital-diagnosed ALC experience an early return to the hospital and most die within 6 months. These patients may benefit from increased access to palliative and other supportive care during index hospitalization to prevent subsequent health care utilization.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Hospitals
  • Humans
  • Lung Neoplasms* / therapy
  • Medicare
  • Patient Discharge
  • Patient Readmission*
  • Retrospective Studies
  • Risk Factors
  • United States