Lung cancer – standardised 28-day readmission ratio following surgery

Metric

The ratio of the observed number of readmissions to the expected number of readmissions, multiplied by 100.

Numerator

All spells with an emergency readmission within 28 days of discharge.

Denominator

Expected number of readmissions within 28 days for patients who have received surgery for lung cancer. Any inpatient with a primary procedure of the following OPCS code:

• E54 Excision of lung

Equivalent to “Excision of lung” procedure group in the DFI tools

And a primary diagnosis of one of the following ICD10 codes:

• C33 Malignant neoplasm of trachea
• C34 Malignant neoplasm of bronchus and lung

Data Source

SUS – CDS

Time frame

April 2010 – March 2011

Basis

Acute trust

Statistical methods used

Expected counts are derived from logistic regression, adjusting for:

• Sex
• Age on admission (in five year bands up to 90+)
• Admission method (non-elective or elective)
• Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
• Procedure subgroup
• Co-morbidities (Dr Foster methodology)
• Number of previous emergency admissions in last 12 months
• Year of discharge (financial year)
• Palliative care (if any episode in the spell has the treatment function code 315 or contains ICD10 code Z515 in any of the diagnoses fields)
• Month of admission
• Source of admission

Logistic regression

The ratio is calculated by dividing the actual number of readmissions by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has a SRR of 100, that means that the number of patients who were readmitted is exactly as would be expected taking into account the standardisation factors. A SRR above 100 means more patients were readmitted than would be expected; one below 100 means that fewer than expected were readmitted.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ – that is, where the trust’s rate diverges significantly from the national rate.

Data points falling above the upper 99.8% control limit are said to be significantly ‘higher than expected’, data points falling below the lower 99.8% control limit are said to be significantly ‘lower than expected’, otherwise ‘within expected range’.

Notes

ICD10 contains no TNM staging information therefore we have tried to reproduce the essence using primary and secondary diagnosis fields. ‘Local spread’ requires the presence of a code for a local lymph node AND the absence of codes for distant nodes or organs. ‘Distant spread’ requires the presence of a code for distant nodes or organs (there may also be codes for local node or organ involvement present).

The denominator procedure group “Excision of lung” will be organised into the following procedure subgroups within the DFI tools and for the purposes of risk adjustment. This indicator is a collation of the first 3 subgroups.

Subgroup title	Primary diagnosis codes	Secondary diagnosis codes
1. Lung only, no nodes	C33, C34	No other C
2. Lung only, local nodes	C33, C34	C771 (intrathoracic lymph nodes) and no other C77-C79
3. Lung only, distant spread	C33, C34	C77-C79 excl C771
4. Other neoplasms	C00-D48 but not C33,C34	Any
5. All other diseases	Not C00-D48	Any

Comment from the Dr Foster Hospital Guide Team

We suggest further refining the table above to provide greater definition. The new codes would be:

Subgroup title	Primary diagnosis codes	Secondary diagnosis codes
1. Lung, no nodes	C33, C34	Any excl C77-C79
2. Lung, local spread	C33, C34	C771 (intrathoracic lymph nodes) if no other C77-C79
3. Lung, distant spread	C33, C34	C77-C79 excl C771
4. Other tumours	C00-D48 but not C33,C34	Any
5. All other disease	Any except C00-D48	Any