The Relationship Between Length of Stay and Increased Infection Rates in Trauma Patients with a Delay in Hospital Discharge.

Authors:
Fabiana C Sanchez, Grant V Bochicchio, Leonardo J Diaz Gandica, Marco J Henriquez, Melissa Canas, Michael W Alchaer, Ricardo A Fonseca

Body of Abstract:
Background:
A substantial body of literature explores the impact of length of stay (LOS) on complications, infections, morbidity, and mortality. However, detailed analyses of specific intervals within LOS and their contributions to patient outcomes, particularly in the context of delayed discharge, remain limited.
Methods:
We conducted an analysis of our multidisciplinary, prospectively maintained trauma database, including all trauma patients with a delay in discharge from 2018 to 2023 at our Level 1 trauma center. Patients with discharge delays related to non-medical reasons and those with delays related to COVID-19 were excluded.
LOS was defined as the total hospital stay. LOS minus delay in discharge time (LOS – DDT) was defined as the duration from admission to when patients were medically ready for discharge ([Phase I]), and DDT was defined as the time from when patients were medically ready for discharge to their actual discharge ([Phase II]). Patients were stratified into two cohorts: those with delays due to infections (DDI) and those with delays due to non-infectious medical reasons (DDNI).
Results:
Among 160 patients with a delay in discharge, 15 (9.4%) were in the DDI group, and 145 (90.6%) were in the DDNI group. Patients in the DDNI group were more likely to be African American (31.7% vs. 0%, p=0.035). Compared to DDNI patients, those in the DDI group had significantly higher total LOS (17.4 days vs. 9.58 days, p<0.001), higher LOS - DDT (11 days vs. 6.18 days, p=0.008), and higher DDT (6.4 days vs. 3.4 days, p<0.001). In a multivariate analysis controlling for Injury Severity Score (ISS), female sex, Glasgow Coma Scale (GCS), and age, LOS - DDT was significantly associated with DDI patients, with an odds ratio (OR) of 1.133 (p=0.017). Conclusion: A higher LOS - DDT ([Phase I]) was associated with increased infection rates among trauma patients experiencing delayed discharge for medical reasons. Additionally, the presence of infection correlated with longer DDT ([Phase II]). These findings suggest the need for strategies to optimize hospital discharge processes and minimize prolonged hospital stays to reduce the risk of infections.