Factors Associated with Prolonged Length of Stay in Intensive Care Unit: Systematic Review and Meta-analysis

Nashwa M. Radwan, Nagla E. Mahmoud, Amal H. Alfaifi, Khaled I. Alabdulkareem

Abstract


Background: Prolonged length of Stay (PLOS) increases the risk of hospital-acquired infections and disrupts patient flowand access to care due to bed shortages. The extent to which PLOS is attributable to complications, patient characteristics, illness, or inefficienpractice style is unclear. Objectives: To determine risk factors associated with prolonged length of stay (PLOS) in intensive care unit. (ICU). Search methods: We searched the COCHRANE, MEDLINE, TRIP and EMBASE from 2010 till now. Selection criteria: We included all the studies published in English language from 2010 till now and investigated the PLOS in ICU after any medical condition. Data collection and analysis: Two authors independently assessed trials eligibility and risk of bias and extracted data. Review Manager 5.3 was utilized to manage the data. Main results: The review included 84719 participants from fourteen observational studies that had some degree of risk of bias and substantial heterogeneity. Post-operative sepsis/ septic shock and the severity of illness of the patients at hospital admission were the most common risk factors for PLOS (OR= 5.65, CI= 1.98, 16.08 and OR=3.95, CI= 1.67, 9.34 respectively), followed by emergency operation (OR= 2.68, CI= 1.56, 4.62), and comorbidities including renal failure and coronary heart disease (OR= 2.64, CI=1.26, 5.51 and OR=2.57, CI= 1.61, 4.10 respectively). Other variables associated with PLOS were respectively; pre-operative condition (OR=2.36, CI=1.28, 4.34), long term use of corticosteroids (OR= 2.03, CI= 1.81, 2.29 ), age >70 years (OR=1.89, CI=0.54, 2.32), operation duration >180 minutes (OR=1.86, CI=1.46, 2.38), most deprived condition (OR= 1.82, CI= 1.15, 2.89), diabetes (OR= 1.36, CI=1.18, 1.56), hypertension (OR=1.32, CI= 1.09, 1.62), smoking (OR=1.25, CI= 1.13, 1.39) and male sex (OR= 1.11, CI=1.06, 1.17). Authors conclusion: Identificationof risk factors associated with PLOS provides the opportunity for intervention to reduce the LOS and support efficient/optimause of hospital resources.

Keywords


Prolonged Length of Stay, Risk Factors, Extended Length of Stay, Patients, Intensive Care Unit

Full Text:

PDF

References


- Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, and McGee G. “Factors influencing length of stay in the intensive care unit, “The American Journal of Critical Care 2006; 15(5): 502–509.

- Thungjaroenkul P, Cunmings GG, and Embleton A. “The impact of nurse staffing on hospital costs and patient length of stay: a systematic review,” Nursing Economics 2007; 25 (5): 255–265.

- Damle RN, Cherng NB, Flahive JM., et al. Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs. Dis Colon Rectum 2014; 57: 1421–1429.

- Dekker JW, Gooiker GA, Bastiaannet E., et al. Cause of death the first year after curative colorectal cancer surgery; a prolonged impact of the surgery in elderly colorectal cancer patients. Eur J Surg Oncol 2014; 40: 1481–1487.

- Martin CM, Hill AD, Burns K, and Chen LM. “Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays,” Critical Care Medicine 2005; 33 (9):1922–1927.

- Laupland KB, Kirkpatrick AW, Kortbeek JB, and Zuege DJ. “Long-term mortality outcome associated with prolonged admission to the ICU,” Chest 2006; 129 (4): 954–959.

- Trottier V, McKenney MG, Beninati M, Manning R, and Schulman CI. “Survival after prolonged length of stay in a trauma intensive care unit,” Journal of Trauma—Injury, Infection and Critical Care 2007; 62 (1): 147–150.

- Huang YC, Huang SJ, Tsauo jy, and Ko WJ. “Definition, risk factors and outcome of prolonged surgical intensive care unit stay,” Anaesthesia and Intensive Care 2010; 38 (3):500– 505.

- Ettema RGA, Peelen LM, Kalkman CJ, Nierich AP, Moons KJM, and Schuurmans MJ. “Predicting prolonged intensive care unit stays in older cardiac surgery patients: a validation study,” Intensive Care Medicine 2011;37 (9):1480–1487.

- Kelly M, Sharp L, Dwane F, et al. Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res 2012; 12: 77.

- Al-Refaie WB, Parsons HM, Habermann EB, et al. Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old. Ann Surg 2011; 253: 947–952.

- Faiz O, Haji A, Burns E, et al. Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals. Colorectal Dis 2011; 13: 816–822.

- Morris AM, Baldwin LM, Matthews B, et al. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 2007; 245: 73–79.

- Collins TC, Daley J, Henderson WH, et al. Risk factors for prolonged length of stay after major elective surgery. Ann Surg 1999; 230: 251–259.

- Bo M, Fonte G, Pivaro F, et al. Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatr Gerontol Int 2016; 16:314-21.

- Lim SC, Doshi V, Castasus B, Lim JKH, Mamun K. Factors causing delay in discharge of elderly patients in an acute care hospital. Ann Acad Med Singap. 2006; 35(1):27–32.

- Earnest A, Chen MIC, Seow E. Exploring if day and time of admission is associated with average length of stay among inpatients from a tertiary hospital in Singapore: an analytic study based on routine admission data. BMC Health Serv Res. 2006; 6:6.

- Cohen ME, Bilimoria KY, Ko CY, et al. Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program. Ann Surg 2009; 250:901–7.

- International Statistical Classification of Diseases (ICD). http://www. who.int/classifications/icd/en/. Accessed on May 22, 2015.

- Bucerius J, Gummert JF, Walther T, et al. Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med 2004;30: 88 –95.

- Janssen DP, Noyez L, Wouters C, Brouwer RM. Preoperative prediction of prolonged stay in the intensive care unit for coronary bypass surgery. Eur J Cardiothorac Surg 2004;25: –7.

- Lateef F. Long Stayers in restructured hospitals. In: Ministry of Health, Singapore. Available at: https://www.moh.gov.sg/content/moh_web/home/pressRoom/ Parliamentary_QA/2013/long-stayers-in-restructured-hospitals-.html. Accessed May 20, 2015.

- Abbott AM, Parsons HM, Tuttle TM, et al. Short-term outcomes after combined colon and liver resection for synchronous colon cancer liver metastases: a population study. Ann Surg Oncol 2013; 20: 139–147.

- Gohil R, Rishi M and Tan BH. Preoperative serum albumin and neutrophil lymphocyte ratio are associated with prolonged hospital stay following colorectal cancer surgery. Br J Med Med Res 2014; 4: 481–487.

- Lobatoa LF, Ferreirab PCA, Wickc EC, Kirand RP, Remzid FH, Kaladyd MF and Vogeld JD. Risk factors for prolonged length of stay after colorectal surgery. J. Coloproctol. (Rio J.) vol.33 no.1 Rio de Janeiro Mar./Apr. 2013 https://doi.org/10.1590/S2237-93632013000100005

- Morimoto Y, Mizuno H, Akamaru Y, et al. Predicting prolonged hospital stay after laparoscopic cholecystectomy. Asian J Endosc Surg. 2015; 8(3):289–95.

- Horn SD, Horn RA. Reliability and validity of the Severity of Illness Index. Med Care 1986; 24:159-78.

- Table of Surgical Procedures, Ministry of Health. Accessed 3 May 2016 from https://www.moh.gov.sg/content/dam/moh_web/Healthcare_Financing/ Medisave/TOSP%20Booklet%20with%20MSP%20(3%20Jan%202017).pdf. Accessed 26 Dec 2017.

- Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen; The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

- Wells GA, Shea B, Connell DO, Peterson J, Welch V, Losos M and Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses 2019.

- Guyatt GH1, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 336: 924.

- Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta analyses. BMJ 2003; 327: 557 560.

- Almashrafi A, Elmontsri M and Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Services Research 2016; 16:318 DOI 10.1186/s12913-016-1591-3

- Walędziak M, Lasek A, Wysocki M, Su M, Bobowicz M, Myśliwiec P. et al. Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Scientific Reports 2019; 9:14793 | https://doi.org/10.1038/s41598-019-51172-2

- Garza BAM, Zamudio PFB, Herrero AG, Zuñiga AC, Vega YC, Stalnikowitz DK and Osornio JS. Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. PLOS ONE 2018; November 8|https://doi.org/10.1371/journal.pone.0207203

- Cocker J, Messaoudi N, Stockman BA, Bossaert LL, and Rodrigus IER. Preoperative prediction of intensive care unit stay following cardiac surgery. European Journal of Cardio-thoracic Surgery 2011; 39: 60—67 www.elsevier.com/locate/ejcts

- Herman C, Karolak W, Yip AM, Buth KJ, Hassan A and Le´gare JF. Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery – development of an entirely preoperative scorecard. Interactive CardioVascular and Thoracic Surgery 2009; 9:654–658.

- Ghotkar SV, Grayson AD, Fabri BM, Dihmis WC and Pullan DM. Preoperative Calculation of Risk for Prolonged Intensive Care Unit Stay Following Coronary Artery Bypass Grafting. J Cardiothorac Surg. 2006; 31; 1:14. doi: 10.1186/1749-8090-1-14.

- Chan CL, Ting HW and Huang HT. Spontaneous Intracerebral Haemorrhage Patients: An Application with National Health Insurance Research Database BioMed Research International Volume 2014, Article ID 891725, 9 pages http://dx.doi.org/10.1155/2014/891725.

- Choi SK, Kim CK, Jo DI, Lee MC, Kim JN, Choi HG, Shin DH and Kim SH. Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study. Arch Plast Surg 2017; 44:539-544 https://doi.org/10.5999/aps.2017.01207.

- Stein M, Misselwitz B, Hamann GF, Kolodziej MA, Reinges MH and Eberhard U Defining Prolonged Length of Acute Care Stay for Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Haemorrhage: A Population-Based Analysis. BioMed Research International Volume 2016, Article ID 9095263, 6 pages http://dx.doi.org/10.1155/2016/9095263




DOI: http://dx.doi.org/10.7575/aiac.abcmed.v.9n.1p.30

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2021 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine