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

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.