The burden of excess length of stay in trauma patients

Oral Presentation at the American College of Surgeons Quality and Safety Conference, 21st-24th July 2017, New York City, New York. Oral Presentation at the Western Regional Chapter of the American College of Surgeons Annual Meeting, 2nd-4th December 2016, Los Angeles, California. Oral Presentation at the Arizona Chapter of the American College of Surgeons Annual Meeting, 19th-20th November 2016, Tucson, Arizona (Best paper award).
https://doi.org/10.1016/j.amjsurg.2018.07.044Get rights and content

Highlights

  • Most common cause of excess hospital stay was placement in skilled nursing facility.

  • 36.4% patients developed complications after completion of medical care.

  • After completion of medical care, the most common complication was UTI.

  • Each excess day in the hospital was associated with 5% higher odds of complications.

Abstract

Background

Disposition of trauma patients frequently results in excessive hospital-stay. The aim of this study was to assess the risk of developing complications due to excessive stay in the hospital.

Methods

Over a period of 4 years (2012–2015) we analyzed all trauma patients with hospital length-of-stay (h-LOS) >30 days. Outcome measures were complications after termination of medical care.

Results

416 patients were identified having h-LOS>30 days of which 61.0% (254) had an excess hospital stay and were included. The most common causes of excess hospital stay were placement in SNiF followed by placement in Inpatient-Rehabilitation. Excessive hospital-stay was independently associated with the development of complications (p = 0.004). Each excess day in the hospital after completion of medical care was associated with 5% higher odds of complications (OR [95%CI]: 1.05[1.02–1.09]) independent of presenting condition of the patient.

Conclusion

Each extra day spent in the hospital after completion of medical care was associated with higher odds of developing complications.

Section snippets

Background

Healthcare expenditures totaled $3.2 trillion in 2015, representing 17.8% of the U.S. GDP.1 Approximately $10 billion is spent annually treating hospital-acquired infections (HAIs).2 There have been increasing efforts to improve both the quality and value provided in healthcare systems. One of the areas of continued study is reducing the excess length of stay in hospital patients. Excess or prolonged length of stay is defined as the number of additional days a patient spends as an inpatient

Methods

We performed a 6-year (2008–2014) retrospective analysis of all trauma patients. The analysis was performed on a prospectively collected comprehensive database that encompassed all trauma patients admitted to the University of Arizona Medical Center, a Level-I trauma center in Tucson, Arizona. This study was conducted after approval from the institutional review board at the University of Arizona, College of Medicine.

Results

Over the six-year study period, a total of 415 patients were identified having a hospital length of stay greater than 30 days. Mean age was 44.1 ± 19.4 years, 74% were males, and 74.5% were white. Median GCS on arrival was 14 [3–15], and median ISS was 26 [17–34]. 271 (65.3%) of these patients had an excess length of stay. Table 1 summarizes the study population demographics information and injury characteristics. There was no difference in demographics, vital and injury parameters between the

Discussion

The continued rise of the cost of health care has forced the industry to identify the major drivers of these costs in an effort to improve operational efficiency and deliver higher quality care. Value in healthcare has been defined as outcomes in relation to costs, and efforts have been undertaken by institutions to seek better outcomes at reduced costs.8 While certain fixed costs in healthcare are seemingly immutable, excessive or prolonged length of stay has been identified as a major driver

Conclusion

Excess length of stay after completion of medical care is associated with higher odds of developing complications. Each excess day in the hospital was associated with 5% higher odds of complications independent of presenting condition of the patient. Excess LOS and associated development of complications are a substantial financial burden, and measures should be instituted to ensure patients do not stay in the hospital longer than necessary.

Conflicts of interest

There are no identifiable conflicts of interests to report.

The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

None.

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