Does the length of stay in hospital affect healthcare outcomes of patients without COVID-19 who were admitted during the pandemic? A retrospective monocentric study

Fluck, David; Fry, Christopher; Rankin, Suzanne; Lewis, Andrea F.; Robin, Jonathan; Rees, Jacqui; Finch, Jo; Jones, Yvonne; Jones, Gareth; Tudose, Julia; Taylor, Liz; Han, Thang S.

doi:10.1007/s11739-022-02945-7

Cited by 7 publications

(7 citation statements)

References 25 publications

(23 reference statements)

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“…In addition, we have also shown a lower risk of mortality amongst non-COVID-19 patients admitted during the pandemic compared to those admitted before the pandemic, particularly if in the highest LACE index category. These findings are in consistent with our previous report [ 20 ] and suggest that the standard of care-quality of patients admitted with general medical conditions continued to be maintained, or even increased, during the pandemic.…”

Section: Discussionsupporting

confidence: 93%

High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

et al. 2022

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Risk factors for COVID-19-related outcomes have been variably reported. We used the standardised LACE index to examine admissions and in-hospital mortality associated with COVID-19. Data were collected in the pre-pandemic period (01-04-2019 to 29-02-2020) from 10,173 patients (47.7% men: mean age ± standard deviation = 68.3 years ± 20.0) and in the pandemic period (01-03-2019 to 31-03-2021) from 12,434 patients. With the latter, 10,982 were without COVID-19 (47.4% men: mean age = 68.3 years ± 19.6) and 1452 with COVID-19 (58.5% men: mean age = 67.0 years ± 18.4). Admissions and mortality were compared between pre-pandemic and pandemic patients, according to LACE index. Admission rates rose disproportionately with higher LACE indices amongst the COVID-19 group. Mortality rates amongst the pre-pandemic, pandemic non-COVID-19 and COVID-19 groups with LACE index scores < 4 were 0.7%, 0.5%, 0%; for scores 4–9 were 5.0%, 3.7%, 8.9%; and for scores ≥ 10 were: 24.2%, 20.4%, 43.4%, respectively. The area under the curve receiver operating characteristic for predicting mortality by LACE index was 76% for COVID-19 and 77% for all non-COVID-19 patients. The risk of age and sex-adjusted mortality did not differ from the pre-pandemic group for COVID-19 patients with LACE index scores < 4. However, risk increased drastically for scores from 4 to 9: odds ratio = 3.74 (95% confidence interval = 2.63–5.32), and for scores ≥ 10: odds ratio = 4.02 (95% confidence interval = 3.38–4.77). In conclusion, patients with LACE index scores ≥ 4 have disproportionally greater risk of COVID-19 hospital admissions and deaths, in support of previous studies in patients without COVID-19. However, of importance, our data also emphasise their increased risk in patients with COVID-19. Because the LACE index has a good predictive power of mortality, it should be considered for routine use to identify high-risk COVID-19 patients.

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Section: Discussionsupporting

confidence: 93%

High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

et al. 2022

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“…These factors were complications arising from primary diagnoses or MM, frailty necessitating integrated rehabilitation, and patient-centred needs. [13] Our findings were similar to a recent Singaporean study that showed how continuity of integrated care in the community was considerably affected during the COVID-19 pandemic. In their study, reluctance or hesitancy from formal and informal caregivers to accept community services due to fear of contracting COVID-19 infection resulted in many patients experiencing delayed LOS.…”

Section: Discussionsupporting

confidence: 90%

Time-to-event analysis of factors influencing delay in discharge from a subacute Complex Discharge Unit during the first year of the pandemic (2020) in an Irish tertiary centre hospital

Rajendran

Rameli

Malomo

et al. 2023

Preprint

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BackgroundThere is a paucity of data investigating delays in discharges from subacute complex care units exclusively dealing with complex cases. We aimed to analyse factors causing delays in discharges and explore their implications on the healthcare system in terms of length of stay (LOS), during the COVID-19 pandemic, using time-to-event analysis, to assist in future pandemic healthcare planning decisions.MethodsSingle-centre, retrospective, cross-sectional study. Demographics, clinical characteristics and length of stay (LOS) of all patients admitted to our subacute Complex Discharge Unit at our model 4 hospital during the pandemic were retrieved from electronic patient records. The outcome variable in our time-to-event analysis was a delay in discharge with a LOS >15 days. A cox proportional hazards regression model delineated factors contributing to delays.Results390 patients were admitted between March 2020 - February 2021 to the subacute complex discharge unit. Among these, 326 (83.6%) patients were >65 years of age, and 233 (59.7%) patients were female. The median (IQR) age was 79 (70-86) years, with a median (IQR) LOS of 19.4 (10-41) days. A total of 237 (60.7%) events were uncensored, LOS > 15 days of which 138 (58.2%) were female, 124 (52.32%) had >4 comorbidities, and 153 (39.2%) were censored into LOS ≤15 days and death 19 (4.8%). Kaplan Meier’s plot allowed the comparison of factors causing a delay in discharge to single factors: age, gender, and multimorbidity. A multivariate cox regression analysis adjusted to each strata age, gender and multimorbidity predicted factors affecting LOS: Age strata 65 - 75 & 75 - 85 [HR 0.233; 95% CI (0.077-.708); p=.010] & [HR .301; 95% CI(.155-.588); p<.001] had common factor patient-centred needs prolonging LOS. The common factors complications arising from comorbidities in male [HR .145; 95 % CI (.081 -.261); p<.001] and female [HR .479; 95% CI (.311 -.737); p<.001], and patient-centred needs in male [HR .472; 95 % CI (.243 -.917); p.027] female [HR .361; 95% CI (.215 -.608); p<.001] exhibited statistically significant results.ConclusionReducing LOS is imperative for better patient outcomes and hospital management. The most common factors delaying discharge were complexities that arose from primary diagnoses and patient-centred needs such as cognition, psychosocial needs and carer needs. Further research is needed into exploring multimorbidity as a risk factor for mortality in patients who experience prolonged LOS within a complex discharge unit.

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“…Prospective data of consecutive admissions to an acute general medical department in a Surrey, UK hospital, were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021; Fluck et al, 2021Fluck et al, , 2022. The hospital is the largest provider of acute hospital services in Surrey, serving a population of 450 000.…”

Section: Study Design Participants and Settingmentioning

confidence: 99%

Influences of the COVID‐19 pandemic on admissions and clinical outcomes in mental health disorders and self‐poisoning: Age‐ and sex‐specific analysis

Fluck

Fry

Robin

et al. 2023

Int J Mental Health Nurs

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We measured rates of hospital admissions for mental health disorders and selfpoisoning during the pandemic in patients without COVID-19, compared to those admitted before the pandemic. Data were collected from 01/04/2019 to 31/03/2021, including the pandemic period from 01/03/2020. There were 10 173 (47.7% men) from the pre-pandemic and 11 019 (47.5% men) from the pandemic periods; mean age = 68.3 year. During the pandemic, admission rates for mental health disorders and self-poisoning were higher for any given age and sex. Self-poisoning was increased with toxic substances, sedatives and psychotropic drugs, but reduced with nonopioid analgesics. Patients admitted with mental health disorders had lower readmission rates within 28 days during the pandemic, but did not differ in other outcomes. Outcomes from self-poisoning did not change between the two study periods.

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Does the length of stay in hospital affect healthcare outcomes of patients without COVID-19 who were admitted during the pandemic? A retrospective monocentric study

Cited by 7 publications

References 25 publications

High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

Time-to-event analysis of factors influencing delay in discharge from a subacute Complex Discharge Unit during the first year of the pandemic (2020) in an Irish tertiary centre hospital

Influences of the COVID‐19 pandemic on admissions and clinical outcomes in mental health disorders and self‐poisoning: Age‐ and sex‐specific analysis

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