Predictors Of Prolonged Length Of Stay Research Articles

Predictors of Prolonged Hospital Stay After Microsurgery for Vestibular Schwannoma: Analysis of a Decade of Data.

Microsurgical resection is one of the treatments for vestibular schwannomas (VS). While several factors have been linked to increased length of stay (LOS) for VS patients undergoing microsurgery, a better understanding of these factors is important to provide prognostic information for patients. Determine predictors of increased LOS for VS patients undergoing microsurgical resection. Retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2020. Database review. All patients who underwent microsurgery (CPT codes 61520, 61526/61596) for the management of vestibular schwannoma (ICD9 and ICD10 codes 225.1, D33.3) were included. Analyzing perioperative factors that can predict prolonged hospital stay. A total of 2096 cases were identified and 1,188 (57%) of these patients were female. The mean age was 51.0 ± 14.0 years. Factors contributing to prolonged LOS included African American race (OR = 2.11, 95% CI: 1.32-3.36, p = 0.002), insulin-dependent diabetes mellitus (OR = 2.12, 95% CI: 1.09-4.4.11, p = 0.026), hypertension (OR = 1.26, 95% CI: 1-1.58, p = 0.046), functional dependency (OR = 5.22, 95% CI: 2.31-11.79, p = 0.001), prior steroid use (OR = 1.96, 95% CI: 1.18-3.15, p = 0.009), ASA class III (OR = 2.06, 95% CI: 1.18-3.6, p < 0.011), ASA class IV (OR = 6.34, 95% CI: 2.62-15.33, p < 0.001), and prolonged operative time (OR = 2.14, 95% CI: 1.76-2.61). Microsurgery by a translabyrinthine (TL) approach compared to a retrosigmoid (RSG) approach had lower odds of prolonged LOS (OR = 0.67, 95% CI: 0.54-0.82, p < 0.001). In a separate analysis regarding patients receiving reoperation, operative time was the only predictor of prolonged LOS (OR = 2.77, 95% CI: 1.39-5.53, p = 0.004.). Our analysis offers an analysis of the factors associated with a prolonged LOS for the surgical management of VS. By identifying healthcare disparities, targeting modifiable factors, and applying risk stratification based on demographics and comorbidities, we can work toward reducing disparities in LOS and enhancing patient outcomes.

Predictors of prolonged length of stay in adult patients with respiratory syncytial virus infections - a multi-center historical cohort study.

Several studies have reported risk factors for severe disease and mortality in hospitalized adults with RSV infections. There is limited information available regarding the factors that affect the duration of a patient's hospital length of stay (LOS). This was a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using the International Classification of Diseases, Tenth Revision 10 codes for RSV infection. Mean LOS was computed; prolonged LOS was defined as greater than the mean. We included 360 patients with a mean age (SD) of 69.9 ± 14.7 years, 63.6% (229) were female and 63.3% (228) of white race. The mean hospital LOS was 7.1 ± 5.4 days. Factors associated with prolonged LOS in univariable analysis were old age, body mass index (BMI), smoking status, Charlson Weighted Index of Comorbidity (CWIC), home oxygen, abnormal chest x-ray (CXR), presence of sepsis, use of oxygen, and antibiotics at the time of presentation. Predictors for prolonged LOS on admission in multivariable analysis were age on admission (p < 0.001), smoking status (p = 0.001), CWIC (p = 0.038) and abnormal CXR (p = 0.043). Our study found that age on admission, smoking history, higher CWIC and abnormal CXR on admission were significantly associated with prolonged LOS among adult patients hospitalized with RSV infection. These findings highlight the significance of promptly recognizing and implementing early interventions to mitigate the duration of hospitalization for adult patients suffering from RSV infection.

Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network.

Postoperative length of stay (LOS) significantly contributes to healthcare costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for degenerative conditions of the cervical spine. The secondary objectives were to examine the variability in LOS and institutional practices used to decrease LOS. This was a multicenter observational retrospective cohort study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective anterior cervical discectomy and fusion (ACDF) (1-3 levels) or posterior cervical fusion (PCF) (between C2 and T2) with/without decompression for degenerative conditions of the cervical spine. Prolonged LOS was defined as LOS greater than the median for the ACDF and PCF populations. The principal investigators at each participating CSORN healthcare institution completed a survey to capture institutional practices implemented to reduce postoperative LOS. In total, 1228 patients were included (729 ACDF and 499 PCF patients). The median (IQR) LOS for ACDF and PCF were 1.0 (1.0) day and 5.0 (4.0) days, respectively. Predictors of prolonged LOS after ACDF were female sex, myelopathy diagnosis, lower baseline SF-12 mental component summary score, multilevel ACDF, and perioperative adverse events (AEs) (p < 0.05). Predictors of prolonged LOS after PCF were nonsmoking status, education less than high school, lower baseline numeric rating scale score for neck pain and EQ5D score, higher baseline Neck Disability Index score, and perioperative AEs (p < 0.05). Myelopathy did not significantly predict prolonged LOS within the PCF cohort after multivariate analysis. Of the 8 institutions (57.1%) with an enhanced recovery after surgery (ERAS) protocol or standardized protocol, only 3 reported using an ERAS protocol specific to patients undergoing ACDF or PCF. Patient and clinical factors predictive of prolonged LOS after ACDF and PCF are highly variable, warranting individual consideration for possible mitigation. Perioperative AEs remained a consistent independent predictor of prolonged LOS in both cohorts, highlighting the importance of preventing intra- and postoperative complications.

Association Between β-thalassemia and Atrial Fibrillation: Insights from the United States National Inpatient Sample.

Transfusion-dependent β-thalassemia (thalassemia major and thalassemia intermedia) (BT) requires repeated blood transfusions for survival due to ineffective erythropoiesis. Consequently, iron overload can predispose the patient to atrial fibrillation (AF) despite the improved prognosis achieved with transfusion and chelation therapy. We sought to study the impact of AF on BT patients through a large database analysis. The current study used data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project National Inpatient Sample collected from 2016-2019. A total of 17,150 admissions were included, of which 2100 (12.2%) admissions had a concomitant diagnosis of AF. Admissions with AF were older (mean age, 72.1 vs. 47.3 years; P < .001) and more likely to have congestive heart failure (CHF), hypertension, valvular heart disease, and renal disease. BT admission was associated with a higher AF prevalence than non-BT admission across all age groups. AF was not associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 0.67-2.78; P = .398) or an increased length of stay (LOS) (aOR, 1.00; 95% CI, 0.78-1.29; P = .997) in the general cohort. In a subgroup analysis, AF was associated with increased in-hospital mortality in women (aOR, 2.73; 95% CI, 1.09-6.8; P = .031). Predictors of in-hospital mortality were increasing age, CHF, and liver disease, while predictors of prolonged LOS were diabetes mellitus, CHF, and increasing age. Further studies are warranted to develop strategies to improve the quality of care and outcome in this population.

Abstract 10093: Association Between B-Thalassemia and Atrial Fibrillation: Insights From the United States National Inpatient Sample

Introduction: β-thalassemia (BT) disease requires a lifelong blood transfusion. Despite improved prognosis with transfusion and chelation therapy, the iron overload can predispose to atrial fibrillation (AF). We sought to study the impact of AF on BT patients through large database analysis. Methods: The study used the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) for 2016-2019. Adult BT admissions were included. BT admissions were identified using ICD-10 code (D56.1). Admissions were stratified according to AF presence. A series of multivariate logistic regression was performed to evaluate the impact of atrial fibrillation on BT and to account for potential confounders. Continuous variables were compared using Student t-test, and categorical variables were compared using ꭓ2 tests. Subgroup analysis according to sex was performed. Outcomes evaluated were in-hospital mortality and prolonged length of stay (LOS) ≥ 75th percentile. Results: A total of 17,150 admissions were included, of which 2,100 (12.2%) had an associated diagnosis of AF. Admissions with AF were older (72.1 vs 47.3, P&lt;0.001), white race (66% vs 41%), and more likely to have congestive heart failure (CHF), hypertension, valvular heart disease, and renal disease. BT was associated with higher AF prevalence than non-BT admissions across all age groups. AF was not associated with increased risk of in-hospital mortality in the general cohort nor increased LOS (adjusted odds ratio [aOR]: 1.36 [0.67-2.78], P=0.398, and 1.00 [0.78-1.29], P=0.997, respectively). In subgroup analysis, including only female admissions, AF was associated with increased in-hospital mortality (aOR: 2.73 [1.09-6.8], P=0.031) but not with prolonged LOS (P=0.218). Predictors of in-hospital mortality were age, CHF, and liver disease, while predictors of prolonged LOS were Diabetes Mellitus in addition to CHF and age. Conclusions: We reported significant findings. First, AF is more common in BT compared to the general population, irrespective of age. Second, AF was independently associated with increased mortality in BT females. Third, CHF, liver disease, diabetes, and increased age are poor outcome predictors.

Can Relative Blood Loss and Operative Time Predict Prolonged Length of Stay following Total Joint Arthroplasty? A Retrospective Study from Single Center in Saudi Arabia

Background: Total joint arthroplasty still causes a lot of blood loss, and many patients require blood transfusions thereafter. Blood transfusions can increase the risk of surgical site infection and periprosthetic joint infection, which can lengthen hospital stays and have a negative impact on patient outcomes. Objective: This study aimed to examine if relative blood loss and operative time could predict the postoperative increased length of stay following total joint arthroplasty. Patients and methods: A total of 187 procedures done during 2018–2021 were collected. Any revision case or any patient with hematological disorders was excluded. This led to a cohort of 181 procedures. The following data were collected: age, height, weight, body mass index (BMI), sex, procedure, surgery start time, surgery end time, preoperative hemoglobin and hematocrit levels, postoperative hemoglobin and hematocrit levels, number of packed red blood cells (PRBCs) transfused and the volume of each unit, and the length of stay (LOS). Results: In our study, age (p = 0.027, odds ratio = 1.076) and relative blood loss (p = 0.038, odds ratio = 1.036) were predictors of prolonged LOS. Similarly, there was a significant association between age, operative time (p < 0.001) and LOS. Conclusion: The operative time, relative blood loss, and age were found to significantly affect the LOS. However, no significant association was found between LOS and gender or BMI.

Prolonged hospital length of stay in pediatric trauma: a model for targeted interventions.

In this study, trauma-specific risk factors of prolonged length of stay (LOS) in pediatric trauma were examined. Statistical and machine learning models were used to proffer ways to improve the quality of care of patients at risk of prolonged length of stay and reduce cost. Data from 27 hospitals were retrieved on 81,929 hospitalizations of pediatric patients with a primary diagnosis of trauma, and for which the LOS was >24 h. Nested mixed effects model was used for simplified statistical inference, while a stochastic gradient boosting model, considering high-order statistical interactions, was built for prediction. Over 18.7% of the encounters had LOS >1 week. Burns and corrosion and suspected and confirmed child abuse are the strongest drivers of prolonged LOS. Several other trauma-specific and general pediatric clinical variables were also predictors of prolonged LOS. The stochastic gradient model obtained an area under the receiver operator characteristic curve of 0.912 (0.907, 0.917). The high performance of the machine learning model coupled with statistical inference from the mixed effects model provide an opportunity for targeted interventions to improve quality of care of trauma patients likely to require long length of stay. Targeted interventions on high-risk patients would improve the quality of care of pediatric trauma patients and reduce the length of stay. This comprehensive study includes data from multiple hospitals analyzed with advanced statistical and machine learning models. The statistical and machine learning models provide opportunities for targeted interventions and reduction in prolonged length of stay reducing the burden of hospitalization on families.

Delayed hospital discharge after total shoulder arthroplasty: why, and who is at risk?

BackgroundThere is growing policy interest in reducing the length of stay (LOS) after discretionary orthopedic surgery but few data to guide improvement efforts. We characterized the primary reasons and predisposing factors associated with extended LOS after elective total shoulder arthroplasty.MethodsWe retrospectively identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017. Extended LOS was defined as a stay greater than the 75th percentile. Medical records were manually reviewed to ascertain the primary reason for extended LOS. Multivariable logistic regression modeling was used to determine preoperative characteristics associated with prolonged hospitalization.ResultsThe most common reason for extended LOS was pain (41%), followed by medical problems (39%), limited social support (18%), and blood transfusions (2%). Only 41% of patients with delayed discharges had documented adverse events (any medical or surgical problem), all of which were minor. The top 4 medical issues were transient hypoxemia (42%), nausea and/or vomiting (13%), electrolyte abnormalities (12%), and altered mental status (10%). In decreasing order of magnitude, the predictors of prolonged LOS were greater number of self-reported allergies, female sex, unmarried patient, diabetes, lower American Shoulder and Elbow Surgeons score, depression, reverse shoulder arthroplasty, and American Society of Anesthesiologists score of 3 or greater. Operative time did not correlate with LOS.ConclusionsProlonged hospitalizations after shoulder arthroplasty are commonly related to pain and limited social support. Sociodemographic and psychological factors seem to have more influence than patient infirmity and technical issues. These findings support a comprehensive approach to care with attention to the physical, mental, and social determinants of health.

Parameters affecting length of stay in a pediatric emergency department: a retrospective observational study.

Several parameters are associated with prolonged ED-LOS. Notably, morning arrivals represent possible targets for strategies to reduce LOS. What is Known: • Prolonged length of stay (LOS) may affect care delivered to admitted patients in the emergency department (ED) and is well studied in the setting of adult patients with high acuity conditions. • Little is known about parameters which impact LOS in European pediatric EDs. What is New: • Several predictors of prolonged LOS could be identified in a European pediatric setting. • Our results indicate that prolonged LOS is associated with modifiable factors like morning and summer admission, which have the potential to be addressed by modification in staffing, infrastructure, and higher attention to faster processing.

Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study.

Various studies have tried to delimit the predictors of hospital length of stay (LOS) for patients with exacerbated chronic obstructive pulmonary disease (eCOPD), but have been disadvantaged by certain limiting factors. Our goal was to prospectively identify predictors of LOS in these patients and to validate our results. This was a prospective cohort study. Subjects were patients with eCOPD who visited 16 hospital emergency departments (EDs) and who were admitted to the hospital. Data were recorded on possible predictor variables at the ED visit, on admission and 24 hours later, during hospitalization, and on discharge. LOS and prolonged LOS (≥ 9 days, considering the 75th percentile of LOS in our sample) were the outcomes of interest. Multivariate multilevel linear and logistic regression models were employed. A total of 1,453 patients were equally divided between derivation and validation samples. The hospital variable was the best predictor of LOS. Multivariate predictors of LOS, as log-transformed variables, were the hospital, baseline dyspnea and physical activity levels and fatigue at 24 hours, intensive care or intensive respiratory care unit admission, the need for antibiotics, and complications during hospitalization. Predictors of prolonged LOS were also the hospital, baseline dyspnea and fatigue at 24 hours, ICU or IRCU admission, and complications during hospitalization (AUC: 0.77). Models were validated in the validation sample (AUC: 0.75). We identified a number of modifiable factors, including baseline dyspnea, physical activity level, and hospital variability, that influenced the LOS of patients with eCOPD who were admitted to the hospital.

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

OBJECTIVESWe 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).METHODSIncident 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.RESULTSA 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%).CONCLUSIONSHalf 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.

Wasted Hospital Days Impair the Value of Length-of-Stay Variables in the Quality Assessment of Trauma Care

Hospital length of stay (LOS) is frequently used to evaluate the quality of trauma care but LOS may be impacted by nonmedical factors as well. We reviewed our experience with delays in patient discharge to determine its financial consequences and its impact on LOS. We performed an analysis of linked trauma registry and "delayed discharge" databases. Actual LOS (A-LOS) values were compared with calculated ideal LOS (I-LOS) values, and the per cent increase in LOS was calculated. Linear regression analysis was used to identify significant predictors of prolonged LOS. One thousand, five hundred and seventeen patients were studied, with an A-LOS of 6.54 days. Seven per cent of patients experienced discharge delays, resulting in 580 excess hospital days. Calculated I-LOS was 6.15 days, 6.34 per cent lower than A-LOS. Other I-LOS estimates were as much as 25 per cent lower than A-LOS. Estimated excess patient charges associated with delayed discharges were $4,000,000 to $15,000,000. Discharge delays are an infrequent, although costly, occurrence that has a significant impact on LOS. LOS therefore may not be an appropriate metric for assessing the quality of trauma care, and should only be used if it has been corrected for discharge delays. Concerted efforts should be directed towards identifying and correcting the factors responsible for delayed discharge in trauma patients.

Predictors of Inpatient Outcomes in Hospitalized Patients After Left Heart Catheterization

Clinical and laboratory factors predicting inpatient outcomes, specifically in-hospital mortality and length of stay (LOS), have not been defined for hospitalized patients specifically referred for left heart catheterization and coronary angiography (LHC). The objective of the study was to determine these outcomes and their predictors in hospitalized patients after LHC. Multivariate logistic regression models were used to identify risk factors for in-hospital mortality and Cox proportional hazards models were used to identify factors determining LOS in 9,420 consecutive patients hospitalized for LHC. Odds ratio for in-hospital mortality and hazard ratio for prolonged LOS were derived. The strongest predictors of mortality were advanced age, left ventricular (LV) end-diastolic pressure (EDP), LV ejection fraction (EF), systemic blood pressure, and renal insufficiency. Predictors of prolonged LOS were LVEDP, LVEF, 3-vessel coronary artery disease, and valvular disease. Clinical and laboratory characteristics of patients with an LVEF > or =50% were also compared with those of patients with an LVEF <50%. Predictors of mortality and LOS remained the same for patients with an LVEF <50%. For an LVEF > or =50%, LVEDP also determined LOS and chronic renal insufficiency provided predictive power to mortality and LOS in this subgroup. In conclusion, several readily attainable clinical and laboratory parameters predict inpatient mortality and LOS in hospitalized patients referred for LHC.

What keeps postpulmonary resection patients in hospital?

Prolonged air leak (longer than three days) was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS) was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated. Retrospective review of 91 patients. Primary reasons for prolonged hospitalization were determined. Patient characteristics (demographic information, pulmonary function test results, body habitus measurements, smoking history), operative factors (procedure performed, duration of operation, complications) and postoperative factors (time of chest tube removal) were considered. Student's t test and chi2 analysis were used to compare continuous and ratio data, respectively, and linear regression analysis was used to define the equation relating two variables. The mean postoperative LOS was 6.4 days. Only prolonged air leak was predictive of increased LOS (9.4 days versus 5.4 days, P<0.001). Forced expiratory volume in 1 s less than 1.5 L/min, carbon monoxide diffusing capacity less than 80% predicted and the detection of a pneumothorax were all predictive of prolonged air leak. A strong correlation between the time of chest tube removal and LOS was found (r=0.937, P<0.001). Linear regression analysis showed postoperative LOS and duration of thoracostomy tube insertion to be related by the equation y = 0.88x + 2.49 days. These results suggest that increased LOS following pulmonary resection is due primarily to prolonged air leaks. Furthermore, patients who have their chest tubes removed sooner are discharged sooner.