Longer Mean Length Of Stay Research Articles

Fluid overload is associated with increases in length of stay and hospital costs: pooled analysis of data from more than 600 US hospitals

BackgroundFluid overload, including transfusion-associated circulatory overload (TACO), is a serious complication of fresh frozen plasma (FFP) transfusion. The incidence of fluid overload is underreported and its economic impact is unknown. An evaluation of fluid overload cases in US hospitals was performed to assess the impact of fluid overload on length and cost of hospital stay.Study design and methodsRetrospective analysis was performed using a clinical and economic database covering >600 US hospitals. Data were collected for all inpatients discharged during 2010 who received ≥1 unit FFP during hospitalization. Incidence of fluid overload was determined through International Classification of Diagnosis (ICD-9) codes. Multivariate regression analysis was performed for primary outcome measures: hospital length of stay (LOS) and total hospital costs.ResultsData were analyzed for 129,839 FFP-transfused patients, of whom 4,138 (3.2%) experienced fluid overload (including TACO). Multivariate analysis, adjusting for baseline characteristics, found that increased LOS and hospital costs were independently associated with fluid overload. Patients diagnosed with fluid overload had longer mean LOS (12.9 days versus 10.0 days; P < 0.001) and higher mean hospital cost per visit ($46,644 versus $32,582; P < 0.001) compared with patients without fluid overload.ConclusionFor a population of US inpatients who received FFP during hospitalization, fluid overload was associated with a 29% increase in LOS and a $14,062 increase in hospital costs per visit. These findings suggest that the incidence of fluid overload in the general population is greater than historically reported. A substantial economic burden may be associated with fluid overload in the US.

Factors Affecting Length of Stay in the Pediatric Emergency Department

A large volume of visits can cause an emergency department (ED) to become overcrowded, resulting in a longer length of stay (LOS). The objective of this study was to analyze factors affecting the LOS in the pediatric ED. Records of all visits to the pediatric ED of the study hospital, from July 1, 2006 to June 31, 2007, were retrospectively retrieved. Data were collected from the hospital's computerized records system. Eta-squared correlation ratio and Cramer's V test evaluated the associations between variables. Two-thirds of the database was randomized for the classification and regression tree (CART) model-building dataset, and one-third was used for the validation dataset. A total of 29,035 patients visited the pediatric ED during the evaluation period. Of the total visits, 61.1% were due to complaints of fever. The mean LOS was 2.6±4.67hours, and 74.3% of visits had an LOS of shorter than 2hours. The CART analysis selected five factors (waiting time for hospitalization, laboratory tests, door-to-physician time, gastrointestinal symptoms, and patient outcome) to produce a total of nine subgroups of patients. The mean LOS of the model-building dataset closely correlated with that of the validation dataset (r(2)=0.999). Patients who were waiting for hospitalization for less than 8hours or were not admitted, those without any laboratory tests, those having door-to-physician time less than 60minutes, and those without any gastrointestinal symptoms had the shortest LOS. Patients who waited for hospitalization for more than 16hours had the longest LOS.

Hyperglycemia is associated with increased length of stay and total cost in patients hospitalized for congestive heart failure

Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness; however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%; p = 0.01) and total cost >$10,000/patient (46% vs 29%; p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%; p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.

The inpatient experience and predictors of length of stay for patients hospitalized with systolic heart failure: comparison by commercial, Medicaid, and Medicare payer type

Objective:Descriptions of the inpatient experience for patients hospitalized with systolic heart failure (HF) are limited and lack a cross-sectional representation of the US population. While length of stay (LOS) is a primary determinant of resource use and post-discharge events, few models exist for estimating LOS.Research design and methods:MarketScan® administrative claims data from 1/1/2005–6/30/2008 were used to select hospitalized patients aged ≥18 years with discharge diagnoses for both HF (primary diagnosis) and systolic HF (any diagnostic position) without prior HF hospitalization or undergoing transplantation.Results:Among 17,597 patients with systolic HF; 4109 had commercial; 2118 had Medicaid; and 11,370 had Medicare payer type. Medicaid patients had longer mean LOS (7.1 days) than commercial (6.3 days) or Medicare (6.7 days). In-hospital mortality was highest for patients with Medicaid (2.4%), followed by Medicare (1.3%) and commercial (0.6%). Commercial patients were more likely to receive inpatient procedures. Renal failure, pressure ulcer, malnutrition, a non-circulatory index admission DRG, receipt of a coronary artery bypass procedure or cardiac catheterization, or need for mechanical ventilation during the index admission were associated with increased LOS; receipt of a pacemaker device at index was associated with shorter LOS.Limitations:Selection of patients with systolic HF is limited by completeness and accuracy of medical coding, and results may not be generalizable to patients with diastolic HF or to international populations.Conclusion:Inpatient care, LOS, and in-hospital survival differ by payer among patients hospitalized with systolic HF, although co-morbidity and inpatient procedures consistently influence LOS across payer types. These findings may refine risk stratification, allowing for targeted intensive inpatient management and/or aggressive transitional care to improve outcomes and increase the efficiency of care.

Effects of intensivist coverage in a post-anaesthesia care unit on surgical patients' case mix and characteristics of the intensive care unit

IntroductionThere is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the post-anaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients.MethodsThe administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared.ResultsThe relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P <0.005). The mean LOS in the PACU was 0.45 (± 0.41) days, compared to 0.27 (± 0.2) days prior to the implementation. The preoperative times in the hospital decreased significantly for all patients. The case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P <0.001 CMI/hospital day.ConclusionsThe introduction of a PACU and the staffing with intensive care staff might shorten the hospital LOS for surgical patients. The revenues for the hospital, as determined by the case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.

Pediatric Traumatic Amputations and Hospital Resource Utilization in the United States, 2003

Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or healthcare resource burden of amputation injuries, and even less is known about these injuries in the pediatric population. An analysis of patients aged < or =17 years hospitalized with traumatic amputations using the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. National estimates of amputation-associated hospitalizations, rates, resource use, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and length of stay (LOS). In 2003, 956 cases of traumatic amputations among children aged < or =17 years resulted in 21.6 million dollars (standard deviation [SD] = 2.2 million dollars) in inpatient charges and 3,967 days (SD = 354) of hospitalization in the United States. Finger and/or thumb amputations accounted for the majority of injuries (64.0%). Mean (SD) hospital charges and LOS were 23,157 dollars (49,018 dollars) and 4.1 (7.4) days, respectively. Traumatic leg amputations incurred the highest mean hospital charges (120,275 dollars) and longest mean LOS (18.5 days). Older children (15-17 years) experienced a higher hospitalization rate (1.84/100,000) than other age groups. Older age, amputation caused by a motorized vehicle, urban hospital location, children's hospital type, and longer LOS were associated with higher total charges. Amputation caused by lawn mower, motorized vehicle or explosives/fireworks, and children's hospital type were associated with longer LOS. Pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in 21 million dollars in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.

Gender Differences in Hospitalized Patients with Sickle Cell Disease (SCD): 1990–2002.

We show in a companion abstract that there has been no decrease in overall admissions for adults with sickle cell anemia (SCA) in the US for the period 1990–2002. The objective of this study was to further describe the characteristics of all adult and pediatric inpatients with sickle cell disease (SCD) in the US for this period.Methods: We examined data from the National Hospital Discharge Survey (NHDS) for the period 1990–2002. The NHDS is a nationally representative survey of non-federal short-stay hospitals in the U.S. which allows for the estimation of inpatient utilization data. Inclusion criteria for our analysis consisted of the following ICD-9 codes: 282.61 or 282.62 (classified as SS), and 282.60, 282.63, 282.64, and 282.69 (classified as Other/Not Specified) found in any one of seven possible patient diagnostic records. Gender and SCD genotype differences in mean length of stay (LOS) were assessed using univariate analyses, and multivariate analyses adjusting for insurance status, age, hospital bedsize, time, and region of the country. Analyses were conducted for the population in the aggregate, and stratified by adult/pediatric status (18+ years for adults, 0–17 for pediatric).Results: There were 13,221 records, which met our inclusion criteria resulting in an estimate of 1,079,523 SCD discharges over the 13 year period. (83,040 discharges/year) More than half of the adult discharges were for females, while less than half of the pediatric discharges were for females (55% vs. 44%, p < 0.0001). A greater percentage of adult than pediatric discharges were coded as SS (81% vs. 74%, p < 0.0001). Among adults, patients coded as SS were younger than patients with an Other/Not Specified SCD code (30.6 vs. 35, p < 0.001). The reverse was true for pediatric cases, where patients coded as SS were slightly older than patients coded as Other/Not Specified SCD (9.6 vs. 7.7, p < 0.001). In univariate analyses of LOS data, adult females with SS had longer mean LOS than adult males with SS (7.27 days vs. 6.29 days, p = 0.001). There were no differences in mean LOS for adult females and adult males with Other/Not Specified SCD codes (p = 0.160). Adult males with SS and adult males with Other/Not Specified SCD codes did not differ in their mean LOS (p = 0.850), while adult females with SS experienced significantly longer mean LOS than adult females with Other/Not Specified SCD codes (7.27 days vs. 5.45 days, p < 0.001). Among the pediatric cases, females with SS experienced longer LOS than females with Other/Not Specified SCD codes (4.57 days vs. 3.22 days, p < 0.001). Adult females continued to experience nearly a full day longer mean LOS than adult males in multivariate analyses (β = 0.83, p = 0.006). Among adults, 27% of men had medicare compared to 19% of the women and 17% of men compared to 25% of women had private insurance. (p < 0.0001)Conclusions: Our analysis of the characteristics of inpatients with SCD demonstrates that adult females with SCD account for a higher percentage of inpatient visits than adult males with SCD. Females with SS experience longer mean inpatient LOS than females without SS and males with or without SS, regardless of age. The reasons for these differences are unknown, but warrant further study. Of the hosptilized adults more women had private insurance than men. Whether this impacts on likelihood of admissions needs closer examination. A better understanding of patient characteristics will help guide interventions that will limit barriers to care for this patient population.

Attributable costs and length of stay of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit.

To determine the costs of the interventions aimed at controlling the 4-month outbreak and to determine the attributable length of stay (LOS) associated with infection and colonization with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. A retrospective cost analysis was conducted from the hospital perspective. A micro-costing approach was employed. The LOS of four groups of hospitalized patients were compared with each other. National Perinatal Information Center criteria were used to stratify infants for severity of risk. The LOS of each group was compared with that of a national sample of similarly stratified infants. A level III-IV, 45-bed neonatal intensive care unit. Infant groups were infected (n = 8), colonized (n = 14), concurrent cohort (n = 54), and prior cohort (n = 486). The cost of the outbreak totaled 341,751 dollars. The largest proportion of costs was related to healthcare worker time providing direct patient care (2,489 hours at a cost of 146,331 dollars). Infected and colonized neonates had longer LOS than either the concurrent cohort or the prior cohort (P < .001). Compared with the national sample, infected infants had a 48.5-day longer mean LOS (95% confidence interval [CI95], 1.7 to 95.2), whereas the prior cohort's mean LOS was 6 days shorter (CI95, -9.4 to -2.9). This study increases the understanding of the burden of these multidrug-resistant organisms. Further research is needed to estimate the societal costs of these infections and the cost-effectiveness of preventive interventions.

Hospitalization costs associated with leiomyoma

The objective of this study was to determine the prevalence and cost of leiomyoma-related hospitalizations based on the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP-3). Data for 1991 and 1992 were obtained from the HCUP-NIS database, which includes an approximate 20% sample of US hospital discharges. ICD-9 (International Classification of Diseases, Ninth Revision) codes 218.0-218.2 and 218.9 were used to identify women between the ages of 15 and 64 years with the diagnosis of leiomyoma. The distribution of leiomyoma was described using demographic characteristics, admission type, length of stay (LOS), mean total charge, specific leiomyoma diagnosis, principal procedure, and other diagnosed diseases. Among hospital admissions of women between the ages of 15 and 64 years during 1991 and 1992, 26 to 28 admissions per 1000 included a diagnosis of leiomyoma. The highest rates of leiomyoma diagnosis were seen in women aged >40 years (65% and 70% for 1991 and 1992, respectively) and black women (26% and 27%, respectively). Approximately 90% of hospitalizations for leiomyoma were routine admissions, with the most common specific diagnosis being intramural leiomyoma of the uterus. In 1992, patients with leiomyoma as the first diagnosis (vs other diagnoses) had significantly lower mean LOS (3.1 vs 4.4 days; P < 0.001) and mean total charge ($5919 vs $6810; P < 0.001). Total abdominal hysterectomy was performed on three quarters of the women admitted for leiomyoma, and these patients had longer mean LOS and higher total charges than those undergoing other procedures. Although not as costly as other conditions, this common disorder among women of reproductive years requires expensive treatment and is a major burden on the health care system.