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Review
. 2025 Apr 8;9(3):100607.
doi: 10.1016/j.mayocpiqo.2025.100607. eCollection 2025 Jun.

A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections

Bashar Hasan  1   2 , Dima Bechenati  3 , Hannah M Bethel  1 , Sydney Cho  1 , Noora S Rajjoub  1 , Sammy T Murad  1 , Adel Kabbara Allababidi  1   2 , Tamim I Rajjo  3 , Mohammed Yousufuddin  4
Affiliations
Review

A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections

Bashar Hasan et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To systematically review hospital length of stay (LOS) associated with falls, pressure ulcers, central line-associated bloodstream infections, and surgical site infections and their potential differences before and after the implementation of the hospital-acquired condition (HAC) reduction program (HACRP).

Methods: We searched PubMed, Embase, and Cochrane databases from January 1, 2000, to May 26, 2024, for studies examining LOS and health care costs in patients with any of the 4 HACs. Studies included prospective and retrospective cohorts and case-control designs across various clinical settings.

Results: Fifty studies involving 45,080,370 patients admitted for medical and surgical conditions met the inclusion criteria, with 1,939,151 patients experiencing 1 or more HACs. Length of stay increased by an average of 5.2 days for falls, 12.9 days for pressure ulcers, 22.1 days for central line-associated bloodstream infections, and 7.9 days for surgical site infections. After HACRP implementation, LOS for falls increased by 4.9 days, whereas LOS for pressure ulcers decreased by 39.1 days.

Conclusion: This systematic review presents detailed data on excess LOS for 4 selected HACs across medical, surgical, intensive care unit, and rehabilitation settings over the past 25 years. The varying impact of HACRP on different HACs highlights the need for targeted prevention strategies.

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Conflict of interest statement

The authors report no competing interests.

Figures

Figure
Figure
Heatmap of mean differences in length of stay (LOS) for selected hospital-acquired conditions (HACs) between adverse event (AE) and no AE groups across ICU, general inpatient, and rehabilitation settings. CLABSI, central line–associated bloodstream infection; ICU, intensive care unit; SSI, surgical site infection.
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References

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    1. Australian Commission on Safety and Quality in Health Care Hospital-Acquired Complications (HACs) Australian Commission on Safety and Quality in Health Care. 2021
    1. World Health Organization . WHO; 2022. WHO Launches First Ever Global Report on Infection Prevention and Control.
    1. Centers for Medicare and Medicaid Services . CMS; 2015. Hospital-Acquired Conditions.
    1. Agency for Healthcare Research and Quality . AHRQ; 2019. 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy.

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