Brasel Karen J, Lim Hyun J, Nirula Ram, Weigelt John A
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Arch Surg. 2007 May;142(5):461-5; discussion 465-6. doi: 10.1001/archsurg.142.5.461.
Although demographic and clinical information are known to affect hospital length of stay (LOS), we hypothesized that LOS after traumatic injury would be significantly influenced by nonclinical factors.
Retrospective database analysis.
Trauma patients treated at hospitals participating in data submission to the National Trauma Data Bank.
The National Trauma Data Bank was queried for all patients older than 18 years with an LOS longer than 48 hours and complete demographic information including age, sex, and race/ethnicity; nonclinical factors including payment type (commercial, Medicaid, Medicare, uninsured, and other) and discharge destination (home, rehabilitation facility, nursing home, and other); and clinical information (body region injured, Injury Severity Score, and Revised Trauma Score). Statistical analysis was performed using generalized linear modeling adjusted for multiple comparisons.
Length of stay greater than the mean.
We obtained 313 144 medical records. Mean LOS was 9.6 days. Discharge destination had the greatest effect on LOS. Mean LOS for patients with Medicaid (11.3 days) was significantly longer than for patients with commercial insurance and uninsured patients (each 9.3 days) and patients with Medicare (8.8 days). Length of stay was longer for patients discharged to a nursing home (14.2 days) or rehabilitation facility (11.5 days) compared with those discharged to any other facility (9.6 days). In multivariate analysis, factors significantly associated with extended LOS included age, sex, race/ethnicity, insurance status, discharge destination, and Revised Trauma Score.
Nonclinical factors significantly influence LOS. If LOS is used as a quality measure for injured patients, adjustment for these factors is necessary.
尽管已知人口统计学和临床信息会影响住院时间（LOS），但我们推测创伤后住院时间会受到非临床因素的显著影响。
回顾性数据库分析。
向国家创伤数据库提交数据的医院所治疗的创伤患者。
查询国家创伤数据库，获取所有年龄大于18岁、住院时间超过48小时且具备完整人口统计学信息（包括年龄、性别和种族/民族）、非临床因素（包括支付类型[商业保险、医疗补助、医疗保险、未参保和其他]以及出院去向[回家、康复机构、疗养院和其他]）和临床信息（受伤身体部位、损伤严重程度评分和修订创伤评分）的患者。使用广义线性模型进行统计分析，并对多重比较进行校正。
住院时间大于均值。
我们获得了313144份病历。平均住院时间为9.6天。出院去向对住院时间影响最大。接受医疗补助的患者平均住院时间（11.3天）显著长于商业保险患者和未参保患者（均为9.3天）以及医疗保险患者（8.8天）。与出院到其他任何机构的患者（9.6天）相比，出院到疗养院（14.2天）或康复机构（11.5天）的患者住院时间更长。在多变量分析中，与延长住院时间显著相关的因素包括年龄、性别、种族/民族、保险状况、出院去向和修订创伤评分。
非临床因素显著影响住院时间。如果将住院时间用作受伤患者的质量指标，则有必要对这些因素进行校正。
