Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico

Abstract

BackgroundHospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Additionally, these patients represent a significant economic problem on public health systems and their families. We sought to describe and compare characteristics of patients with Normal hospital Length-of-Stay (NLOS) and PLOS to identify sociodemographic and disease-specific factors associated with PLOS in a tertiary care institution that attends adults with complicated diseases from all over Mexico.Materials and methodsWe conducted a retrospective analysis of hospital discharges from January 2000-December 2017 using institutional databases of medical records. We compared NLOS and PLOS using descriptive and inferential statistics. PLOS were defined as those above the 95th percentile of length of hospitalization.ResultsWe analyzed 85,904 hospitalizations (1,069,875 bed-days), of which 4,427 (5.1%) were PLOS (247,428 bed-days, 23.1% of total bed-days). Hematological neoplasms were the most common discharge diagnosis and surgery of the small bowel was the most common type of surgery. Younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status were associated with PLOS. Bone marrow transplant (OR 18.39 [95% CI 12.50–27.05, p<0.001), complex infectious diseases such as systemic mycoses and parasitoses (OR 4.65 [95% CI 3.40–6.63, p<0.001), and complex abdominal diseases such as intestinal fistula (OR 2.57 [95% CI 1.98–3.32) had the greatest risk for PLOS. Risk of mortality in patients with PLOS increased more than threefold (3.7% vs 13.3%, p<0.001).ConclusionsWe report some key sociodemographic and disease-specific differences in patients with PLOS. These could serve to develop a specific model of directed hospital healthcare for patients identified as in risk of PLOS.

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

“…Using the same definition for prolonged hospitalization, O’Sullivan et al conducted a single-centre study within the same jurisdiction as our study and similarly found that 13.1% of hospital admissions were at least 14 days, but used 49.1% of bed days [ 44 ]. Marfil-Garza et al conducted a single-centre study in Mexico and found that 5.1% of admissions had a LOS more than 34 days but used 23.1% of total bed days [ 42 ]. Among general medicine discharges, Anderson et al revealed that 2.3% of discharges were longer than 21 days, but accounted for 18.6% of total inpatient days [ 45 ].…”

“…Several studies have identified factors associated with protracted hospitalization, but many of these have focused on targeted patient populations [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] or involved data collected at a single centre [ 13 , 18 , 19 , 23 , 24 , 28 , 29 , 31 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] Understanding the factors that contribute to prolonged hospitalization in a broader patient cohort may guide the development of interventions that target at risk patients, improve overall care, and reduce resource utilisation.…”

Factors Associated with Prolonged Hospitalization Among Patients Transported by Emergency Medical Services: A Population-based Study in Osaka, Japan

“…However, in a retrospective study at a single tertiary health care center in Mexico, young people, male sex, a lower physician-to-patients rate, weekend hospitalization, presence of surgery, number of complications, residence outside the city and lower socioeconomic status were associated with prolonged hospitalization. 29 According to a WHO (world health organization) report, there were 4.9 million deaths by injury in 2016, of which 1.4 million patients died in road accidents worldwide, three quarters of whom were men or boys. 30 As this study was conducted in a developed country, the differences in health and medical situations in developed and developing countries may affect the results.…”

Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

“…The duration of hospitalization may re ect the severity of diseases, complications rates, and medical costs. Furthermore, studies in geriatric and general populations indicate that prolonged hospitalization is associated with increased functional dependence, infection, and comorbidities [18][19][20].…”