Clinical Characteristics of the Extensively Prolonged Hospitalization: A Retrospective Analysis at a Large Tertiary Medical Center

Abstract

Background: Prolonged hospitalizations have contributed to the concentration of American healthcare spending in a small subset of patients. Research related to such events is scarce. Methods: The authors performed a retrospective analysis of hospitalizations at a tertiary care center between 2012 and 2022. Extensively prolonged hospitalization (EPH) was defined as an uninterrupted hospital stay of at least 183 days. Patient data, including past medical history, hospital complications, barriers to discharge, and long-term outcomes were collected. Results: Among 393,474 unique adult hospitalizations, mean length of stay was 5.49 days. There were 42 EPH, making up 0.01% of all admissions and 0.69% of hospital days. Patients with EPH were 62% male and had a median age of 58.5 years old. EPH featured a mean of 8.88 CTs and 2.12 MRIs. MRSA blood culture positivity was documented in 48% of cases. Mechanical ventilation and gastrostomy tube placement were performed in 88% and 71% of EPH, respectively. In 64% of cases, patients were medically stable for discharge and awaiting post-acute facility bed availability for at least three months. In-hospital death occurred in 31% of cases. Among patients who survived hospitalization, none were able to live independently, and median post-discharge survival was 94 days. At five-year follow-up, 1 patient (2%) was still alive. Conclusions: These findings emphasize the importance of non-medical barriers to discharge in EPH. While larger studies are needed, this study suggests that long-term outcomes in EPH are grim.