Medical complications associated with prolonged length of stay in patients with nontraumatic intracerebral hemorrhage: A nationwide cohort study

Abstract

Purpose: This work aims to investigate the in-hospital medical complications associated with prolonged length of stay (PLOS) in a large cohort of patients with nontraumatic intracranial hemorrhage (ICH), using a nationwide inpatient sample.

Methods: In this retrospective cohort study, the National Inpatient Sample database was investigated for patients admitted with nontraumatic ICH from October 2015 to December 2022. Demographics, comorbidities, markers of ICH severity, in-hospital procedures, PLOS, and hospital mortality were noted. PLOS was defined as length of stay exceeding the 75th percentile of the entire cohort. Outcomes investigated were in-hospital medical complications, including acute ischemic stroke (AIS), seizures, aspiration pneumonia, acute respiratory failure, deep vein thrombosis (DVT), pulmonary embolism (PE), and acute kidney injury (AKI). Multivariable logistic models were used to determine the association between each preselected outcome and PLOS, adjusted for demographics, comorbidities, ICH severity, and surgical procedures. Significant P value was set at 0.05 for all analyses.

Results: Out of 211,879 ICH included in the study, 50,224 (23.7 %) had PLOS. PLOS was defined as a LOS that exceeded 12 days. ICH patients with PLOS were younger (63 [52-73] vs. 70 [58-80]), more likely to be male (56.1 % vs. 51.5 %), Black (25.9 % vs. 18.3 %) or Hispanic (12.4 % vs. 9.7 %), and being in the lower median household income quartile (31.9 % vs. 28.5 %), p < 0.01 for all. In distinct multivariable logistic models, adjusted for demographics, comorbidities, ICH severity, and surgical procedures, AIS (OR: 1.469, 95 %CI: 1.428-1.511), seizures (OR: 1.214, 95 %CI: 1.164-1.265), aspiration pneumonia (OR: 2.911, 95 %CI: 2.809-3.016), acute respiratory failure (OR: 1.527, 95 %CI: 1.48-1.576), DVT (OR: 2.739, 95 %CI: 2.568-2.921), PE (OR: 1.638, 95 %CI: 1.521-1.765), and AKI (OR: 2.037, 95 %CI: 1.978-2.098) were independently associated with PLOS, p < 0.01 for all. Age-stratified analysis revealed that the strongest association with PLOS was observed for DVT in patients < 40 years (OR 3.797, 95 % CI: 2.991-4.822) and for aspiration pneumonia in those ≥ 80 years (OR 3.508, 95 % CI: 3.242-3.795). Patients with PLOS experienced a lower in-hospital mortality rate (13.4 % vs. 22.8 %, p < 0.01).

Conclusions: In this large cohort of ICH patients, racial/ethnic minorities and lower-income patients were more likely to experience PLOS. PLOS was associated with both neurological and medical complications, with aspiration pneumonia showing the strongest association in older patients and DVT in younger patients. Prolonged hospitalization did not impact short-term mortality.

Keywords: Disparities; Length of stay; Medical complications; Nontraumatic intracerebral hemorrhage.