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Hospital Length of Stay and Health Outcomes

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 18196

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Dr. Abbas Smiley, MD, PhD

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Doctor of Medicine, Department of Preventive Medicine, School of Medicine, University of Rochester, Rochester, NY, 14645, USA
Interests: sleep; physical activity; nutrition; lifestyle; chronic disease
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Dear Colleagues,

The question is “To Be or Not To Be” in the Hospital? At the present, there is insufficient data regarding the impact of hospital length of stay on mortality in most diseases. “Time-to-readiness for discharge” depends on many factors such as age, sex, the severity of condition, correct diagnosis of disease, having surgery (time to surgery, emergency vs. elective), comorbidities and complications during hospitalization may all play some roles in the association between hospital length of stay and mortality. Admittedly, it is difficult to reliably determine whether a longer hospital stay can cause hospital-acquired complications or the opposite is true. However, a later onset of complications can indicate that longer hospital stays result in a higher rate of complications, and therefore, a higher in-hospital mortality. In this sense, a hospital stay that is too long offers an unfavorable prognostic marker, particularly for the elderly population, thus providing an opportunity for the improvement of patient care and survival. Then, the question is how long the patient should stay in hospital to have the best outcome. This Special Issue plans to focus on the most recent findings in the field of relationship between hospital length of stay and health outcomes. Potential topics include, but are not limited to: The relationship between short hospital length of stay and health outcomesThe relationship between long hospital length of stay and health outcomes. Strength of associations of hospital length of stay and health outcomes Mechanisms of associations of hospital length of stay and health outcomes.

Dr. Abbas Smiley
Guest Editor

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Keywords

hospital length of stay
health outcomes
chronic disease
complications
comorbidities

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Published Papers (9 papers)

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Research

19 pages, 345 KiB

Open AccessArticle

Elderly Patients Managed Non-Operatively with Abscesses of the Anorectal Region Have Five Times Higher Rate of Mortality Compared to Non-Elderly

by Alexander Ladinsky, Abbas Smiley and Rifat Latifi

Int. J. Environ. Res. Public Health 2023, 20(7), 5387; https://doi.org/10.3390/ijerph20075387 - 4 Apr 2023

Viewed by 1426

Abstract

This study’s purpose was to investigate risk factors for mortality from anorectal abscesses through a more comprehensive examination. This was a retrospective study that evaluated National Inpatient Sample patient data of adult and elderly patients emergently admitted with a primary diagnosis of anorectal abscess. Data was stratified by variables of interest and examined through statistical analysis, including backward logistic regression modelling. Roughly 40,000 adult patients and nearly 7000 elderly patients were admitted emergently with a primary diagnosis of abscess in anorectal regions. The mean age of adult male patients was 43 years while elderly male patients were, on average, 73 years old. Both adult males (69.0%) and elderly males (63.9%) were more frequently seen in the hospital for anorectal abscess compared to females. Mortality rates were lower in adult patients as only 0.2% (n = 62) of adult patients and 1.0% (n = 73) of elderly patients died in the hospital. Age increased the odds of mortality (OR = 1.03; 95% CI: 1.02–1.04, p < 0.001) as did hospital length of stay (OR = 1.02; 95% CI: 1.01–1.03, p < 0.001). Surgical procedure decreased the odds of mortality by more than 50% (OR = 0.49; 95% CI: 0.33–0.71, p < 0.001). Risk factors for mortality from anorectal abscess included age and non-operative management, which leads to prolonged hospital length of stay. Surgical management of anorectal abscesses offered protective benefits. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

23 pages, 2018 KiB

Open AccessArticle

Risk Factors for Mortality in Emergently Admitted Patients with Acute Gastric Ulcer: An Analysis of 15,538 Patients in National Inpatient Sample, 2005–2014

by Maksat Idris, Abbas Smiley, Saral Patel and Rifat Latifi

Int. J. Environ. Res. Public Health 2022, 19(23), 16263; https://doi.org/10.3390/ijerph192316263 - 5 Dec 2022

Cited by 4 | Viewed by 1896

Abstract

Background: Patients admitted emergently with a primary diagnosis of acute gastric ulcer have significant complications including morbidity and mortality. The objective of this study was to assess the risk factors of mortality including the role of surgery in gastric ulcers. Methods: Adult (18–64-year-old) and elderly (≥65-year-old) patients admitted emergently with hemorrhagic and/or perforated gastric ulcers, were analyzed using the National Inpatient Sample database, 2005–2014. Demographics, various clinical data, and associated comorbidities were collected. A stratified analysis was combined with a multivariable logistic regression model to assess predictors of mortality. Results: Our study analyzed a total of 15,538 patients, split independently into two age groups: 6338 adult patients and 9200 elderly patients. The mean age (SD) was 50.42 (10.65) in adult males vs. 51.10 (10.35) in adult females (p < 0.05). The mean age (SD) was 76.72 (7.50) in elderly males vs. 79.03 (7.80) in elderly females (p < 0.001). The percentage of total deceased adults was 1.9% and the percentage of total deceased elderly was 3.7%, a difference by a factor of 1.94. Out of 3283 adult patients who underwent surgery, 32.1% had perforated non-hemorrhagic ulcers vs. 1.8% in the non-surgical counterparts (p < 0.001). In the 4181 elderly surgical patients, 18.1% had perforated non-hemorrhagic ulcers vs. 1.2% in the non-surgical counterparts (p < 0.001). In adult patients managed surgically, 2.6% were deceased, while in elderly patients managed surgically, 5.5% were deceased. The mortality of non-surgical counterparts in both age groups were lower (p < 0.001). The multivariable logistic regression model for adult patients electing surgery found delayed surgery, frailty, and the presence of perforations to be the main risk factors for mortality. In the regression model for elderly surgical patients, delayed surgery, frailty, presence of perforations, the male sex, and age were the main risk factors for mortality. In contrast, the regression model for adult patients with no surgery found hospital length of stay to be the main risk factor for mortality, whereas invasive diagnostic procedures were protective. In elderly non-surgical patients, hospital length of stay, presence of perforations, age, and frailty were the main risk factors for mortality, while invasive diagnostic procedures were protective. The following comorbidities were associated with gastric ulcers: alcohol abuse, deficiency anemias, chronic blood loss, chronic heart failure, chronic pulmonary disease, hypertension, fluid/electrolyte disorders, uncomplicated diabetes, and renal failure. Conclusions: The odds of mortality in emergently admitted geriatric patients with acute gastric ulcer was two times that in adult patients. Surgery was a protective factor for patients admitted emergently with gastric perforated non-hemorrhagic ulcers. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

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13 pages, 398 KiB

Open AccessArticle

COVID-19 Mortality in Public Hospitals in a Brazilian State: An Analysis of the Three Waves of the Pandemic

by Larissa Soares Dell’Antonio, Franciéle Marabotti Costa Leite, Cristiano Soares da Silva Dell’Antonio, Camila Brandão de Souza, Juliana Rodrigues Tovar Garbin, Ana Paula Brioschi dos Santos, Nésio Fernandes de Medeiros Junior and Luís Carlos Lopes-Júnior

Int. J. Environ. Res. Public Health 2022, 19(21), 14077; https://doi.org/10.3390/ijerph192114077 - 28 Oct 2022

Cited by 5 | Viewed by 1816

Abstract

Objective: To analyze COVID-19 deaths in public hospitals in a Brazilian state, stratified by the three waves of the pandemic, and to test their association with socio-clinical variables. Methods: Observational analytical study, where 5436 deaths by COVID-19 occurred in hospitals of the public network of Espírito Santo, between 1 April 2020, and 31 August 2021, stratified by the three waves of the pandemic, were analyzed. For the bivariate analyses, the Pearson’s chi-square, Fisher’s Exact or Friedman’s tests were performed depending on the Gaussian or non-Gaussian distribution of the data. For the relationship between time from diagnosis to death in each wave, quantile regression was used, and multinomial regression for multiple analyses. Results: The mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third wave. In the first wave, deaths in public hospitals were associated with the following variables: immunodeficiency, obesity, neoplasia, and origin. In the second wave, deaths were associated with education, O₂ saturation < 95%, chronic neurological disease, and origin. In the third wave, deaths were associated with race/color, education, difficulty breathing, nasal or conjunctival congestion, irritability or confusion, adynamia or weakness, chronic cardiovascular disease, neoplasms, and diabetes mellitus. Origin was associated with the outcome in the three waves of the pandemic, in the same way that education was in the second and third waves (p < 0.05). Conclusion: The time interval between diagnosis and death can be impacted by several factors, such as: plasticity of the health system, improved clinical management of patients, and the start of vaccination at the end of January 2021, which covered the age group with the higher incidence of deaths. The deaths occurring in public hospitals were associated with socio-clinical characteristics. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

17 pages, 333 KiB

Open AccessArticle

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

by Saral Patel, Abbas Smiley, Cailan Feingold, Bardia Khandehroo, Agon Kajmolli and Rifat Latifi

Int. J. Environ. Res. Public Health 2022, 19(16), 10402; https://doi.org/10.3390/ijerph191610402 - 21 Aug 2022

Cited by 6 | Viewed by 1799

Abstract

The goal of this study was to identify risk factors that are associated with mortality in adult and elderly patients who were hospitalized for umbilical hernia. A total of 14,752 adult patients (ages 18–64 years) and 6490 elderly patients (ages 65+), who were admitted emergently for umbilical hernia, were included in this retrospective cohort study. The data were gathered from the National Inpatient Sample (NIS) 2005–2014 database. Predictors of mortality were identified via a multivariable logistic regression, in patients who underwent surgery and those who did not for adult and elderly age groups. The mean (SD) ages for adult males and females were 48.95 (9.61) and 46.59 (11.35) years, respectively. The mean (SD) ages for elderly males and females were 73.62 (6.83) and 77.31 (7.98) years, respectively. The overall mortality was low (113 or 0.8%) in the adult group and in the elderly group (179 or 2.8%). In adult patients who underwent operation, age (OR = 1.066, 95% CI: 1.040–1.093, p < 0.001) and gangrene (OR = 5.635, 95% CI: 2.288–13.874, p < 0.001) were the main risk factors associated with mortality. Within the same population, female sex was found to be a protective factor (OR = 0.547, 95% CI: 0.351–0.854, p = 0.008). Of the total adult sample, 43% used private insurance, while only 18% of patients in the deceased population used private insurance. Conversely, within the entire adult population, only about 48% of patients used Medicare, Medicaid, or self-pay, while these patients made up 75% of the deceased group. In the elderly surgical group, the main risk factors significantly associated with mortality were frailty (OR = 1.284, 95% CI: 1.105–1.491, p = 0.001), gangrene (OR = 13.914, 95% CI: 5.074–38.154, p < 0.001), and age (OR = 1.034, 95% CI: 1.011–1.057, p = 0.003). In the adult non-operation group, hospital length of stay (HLOS) was a significant risk factor associated with mortality (OR = 1.077, 95% CI: 1.004–1.155, p = 0.038). In the elderly non-operation group, obstruction was the main risk factor (OR = 4.534, 95% CI: 1.387–14.819, p = 0.012). Elderly patients experienced a 3.5-fold higher mortality than adult patients who were emergently admitted with umbilical hernia. Increasing age was a significant risk factor of mortality within all patient populations. In the adult surgical group, gangrene, Medicare, Medicaid, and self-pay were significant risk factors of mortality and female sex was a significant protective factor. In the adult non-surgical group, HLOS was the main risk factor of mortality. In the elderly population, frailty and gangrene were the main risk factors of mortality within the surgical group, and obstruction was the main risk factor for the non-surgical group. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

22 pages, 641 KiB

Open AccessArticle

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

by Guy Elgar, Parsa Smiley, Abbas Smiley, Cailan Feingold and Rifat Latifi

Int. J. Environ. Res. Public Health 2022, 19(16), 9905; https://doi.org/10.3390/ijerph19169905 - 11 Aug 2022

Cited by 4 | Viewed by 2459

Abstract

Background: In the United States, ileus accounts for USD 750 million of healthcare expenditures annually and significantly contributes to morbidity and mortality. Despite its significance, the complete picture of mortality risk factors for these patients have yet to be fully elucidated; therefore, the aim of this study is to identify mortality risk factors in patients emergently admitted with paralytic ileus. Methods: Adult and elderly patients emergently admitted with paralytic ileus between 2005–2014 were investigated using the National Inpatient Sample Database. Clinical outcomes, therapeutic management, demographics and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. Results: A total of 81,674 patients were included, of which 45.2% were adults, 54.8% elderly patients, 45.8% male and 54.2% female. The average adult and elderly ages were 48.3 and 78.8 years, respectively. Elderly patients displayed a significantly (p < 0.01) higher mortality rate (3.0%) than adults (0.7%). The final multivariable logistic regression model showed that for every one-day delay in operation, the odds of mortality for adult and elderly patients increased by 4.1% (p = 0.002) and 3.2% (p = 0.014), respectively. Every additional year of age corresponded to 3.8% and 2.6% increases in mortality for operatively managed adult (p = 0.026) and elderly (p = 0.015) patients. Similarly, non-operatively treated adult and elderly patients displayed associations between mortality and advanced age (p = 0.001). The modified frailty index exhibited associations with mortality in operatively treated adults, conservatively managed adults and conservatively managed elderly patients (p = 0.001). Every additional day of hospitalization increased the odds of mortality in non-operative adult and elderly patients by 7.6% and 5.8%, respectively. Female sex correlated to lower mortality rates in non-operatively managed adult patients (odds ratio = 0.71, p = 0.028). Undergoing invasive diagnostic procedures in non-operatively managed elderly patients related to reduced mortality (odds ratio = 0.78, p = 0.026). Conclusions: Patients emergently admitted for paralytic ileus with increased hospital length of stay, longer time to operation, advanced age or higher modified frailty index displayed higher mortality rates. Female sex and invasive diagnostic procedures were negatively correlated with death in nonoperatively managed patients with paralytic ileus. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

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18 pages, 389 KiB

Open AccessArticle

Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy

by Lior Levy, Abbas Smiley and Rifat Latifi

Int. J. Environ. Res. Public Health 2022, 19(15), 9203; https://doi.org/10.3390/ijerph19159203 - 27 Jul 2022

Cited by 4 | Viewed by 1809

Abstract

Background: Colorectal cancer, among which are malignant neoplasms of the rectum and rectosigmoid junction, is the fourth most common cancer cause of death globally. The goal of this study was to evaluate independent predictors of in-hospital mortality in adult and elderly patients undergoing emergency admission for malignant neoplasm of the rectum and rectosigmoid junction. Methods: Demographic and clinical data were obtained from the National Inpatient Sample (NIS), 2005–2014, to evaluate adult (age 18–64 years) and elderly (65+ years) patients with malignant neoplasm of the rectum and rectosigmoid junction who underwent emergency surgery. A multivariable logistic regression model with backward elimination process was used to identify the association of predictors and in-hospital mortality. Results: A total of 10,918 non-elderly adult and 12,696 elderly patients were included in this study. Their mean (standard deviation (SD)) age was 53 (8.5) and 77.5 (8) years, respectively. The odds ratios (95% confidence interval, P-value) of some of the pertinent risk factors for mortality for operated adults were 1.04 for time to operation (95%CI: 1.02–1.07, p < 0.001), 2.83 for respiratory diseases (95%CI: 2.02–3.98), and 1.93 for cardiac disease (95%CI: 1.39–2.70), among others. Hospital length of stay was a significant risk factor as well for elderly patients—OR: 1.02 (95%CI: 1.01–1.03, p = 0.002). Conclusions: In adult patients who underwent an operation, time to operation, respiratory diseases, and cardiac disease were some of the main risk factors of mortality. In patients who did not undergo a surgical procedure, malignant neoplasm of the rectosigmoid junction, respiratory disease, and fluid and electrolyte disorders were risk factors of mortality. In this patient group, hospital length of stay was only significant for elderly patients. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

14 pages, 345 KiB

Open AccessArticle

Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients

by Lior Levy, Abbas Smiley and Rifat Latifi

Int. J. Environ. Res. Public Health 2022, 19(15), 9031; https://doi.org/10.3390/ijerph19159031 - 25 Jul 2022

Cited by 6 | Viewed by 1866

Abstract

Background: Tracheostomy is a procedure commonly conducted in patients undergoing emergency admission and requires prolonged mechanical ventilation. In the present study, the aim was to determine the prevalence and risk factors of mortality among emergently admitted patients with tracheostomy complications, during the years 2005–2014. Methods: This was a retrospective cohort study. Demographics and clinical data were obtained from the National Inpatient Sample, 2005–2014, to evaluate elderly (65+ years) and non-elderly adult patients (18–64 years) with tracheostomy complications (ICD-9 code, 519) who underwent emergency admission. A multivariable logistic regression model with backward elimination was used to identify the association between predictors and in-hospital mortality. Results: A total of 4711 non-elderly and 3315 elderly patients were included. Females included 44.5% of the non-elderly patients and 47.6% of the elderly patients. In total, 181 (3.8%) non-elderly patients died, of which 48.1% were female, and 163 (4.9%) elderly patients died, of which 48.5% were female. The mean (SD) age of the non-elderly patients was 50 years and for elderly patients was 74 years. The mean age at the time of death of non-elderly patients was 53 years and for elderly patients was 75 years. The odds ratio (95% confidence interval, p-value) of some of the pertinent risk factors for mortality showed by the final regression model were older age (OR = 1.007, 95% CI: 1.001–1.013, p < 0.02), longer hospital length of stay (OR = 1.008, 95% CI: 1.001–1.016, p < 0.18), cardiac disease (OR = 3.21, 95% CI: 2.48–4.15, p < 0.001), and liver disease (OR = 2.61, 95% CI: 1.73–3.93, p < 0.001). Conclusion: Age, hospital length of stay, and several comorbidities have been shown to be significant risk factors in in-hospital mortality in patients admitted emergently with the primary diagnosis of tracheostomy complications. Each year of age increased the risk of mortality by 0.7% and each additional day in the hospital increased it by 0.8%. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

20 pages, 385 KiB

Open AccessArticle

Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor

by Guy Elgar, Abbas Smiley and Rifat Latifi

Int. J. Environ. Res. Public Health 2022, 19(14), 8729; https://doi.org/10.3390/ijerph19148729 - 18 Jul 2022

Cited by 5 | Viewed by 1925

Abstract

Background: Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Methods: Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004–2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. Results: In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01–1.18, p = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23–31.37, p = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63–34.11, p = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18–11.71, p = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09–17.91, p = 0.038). Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

16 pages, 1902 KiB

Open AccessArticle

Analysis of Survival of Patients Hospitalized with COVID-19 in Espírito Santo, Brazil

by Juliana Rodrigues Tovar Garbin, Franciéle Marabotti Costa Leite, Luís Carlos Lopes-Júnior, Cristiano Soares da Silva Dell’Antonio, Larissa Soares Dell’Antonio and Ana Paula Brioschi dos Santos

Int. J. Environ. Res. Public Health 2022, 19(14), 8709; https://doi.org/10.3390/ijerph19148709 - 17 Jul 2022

Cited by 6 | Viewed by 2494

Abstract

Objective: To analyze the survival of patients hospitalized with COVID-19 and its associated factors. Methods: Retrospective study of survival analysis in individuals notified and hospitalized with COVID-19 in the state of Espírito Santo, Brazil. As data source, the reports of hospitalized patients in the period from 1 March 2020, to 31 July 2021 were used. The Cox regression analysis plus the proportional risk assessment (assumption) were used to compare hospitalization time until the occurrence of the event (death from COVID-19) associated with possible risk factors. Results: The sample comprised 9806 notifications of cases, with the occurrence of 1885 deaths from the disease (19.22%). The mean age of the group was 58 years (SD ± 18.3) and the mean hospital length of stay was 10.5 days (SD ± 11.8). The factors that presented a higher risk of death from COVID-19, associated with a lower survival rate, were non-work-related infection (HR = 4.33; p < 0.001), age group 60–79 years (HR: 1.62; p < 0.001) and 80 years or older (HR = 2.56; p < 0.001), presence of chronic cardiovascular disease (HR = 1.18; p = 0.028), chronic kidney disease (HR = 1.5; p = 0.004), smoking (HR = 1.41; p < 0.001), obesity (HR = 2.28; p < 0.001), neoplasms (HR = 1.81; p < 0.001) and chronic neurological disease (HR = 1.68; p < 0.001). Conclusion: It was concluded that non-work-related infection, age group above or equal to 60 years, presence of chronic cardiovascular disease, chronic kidney disease, chronic neurological disease, smoking, obesity and neoplasms were associated with a higher risk of death, and, therefore, a lower survival in Brazilian patients hospitalized with COVID-19. The identification of priority groups is crucial for Health Surveillance and can guide prevention, control, monitoring, and intervention strategies against the new coronavirus. Full article

(This article belongs to the Special Issue Hospital Length of Stay and Health Outcomes)

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