Predictors and outcomes associated with prolonged hospital length of stay in intracerebral hemorrhage: a multicenter prospective cohort study in China

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BACKGROUND: Research on factors influencing prolonged length of stay (LOS) and its impact on prognosis in intracerebral hemorrhage (ICH) patients is limited. This study aimed to identify clinical predictors associated with prolonged LOS and to explore the potential impact of prolonged LOS on the prognosis of patients with mild to moderate ICH. METHODS: The study included mild to moderate ICH patients from the China Quality Evaluation of Stroke Care and Treatment (QUEST) database. Prolonged LOS was defined as a hospitalization exceeding 14 days. Sociodemographic characteristics, medical histories, stroke severity, in-hospital treatments, complications, discharge destination, and hospital characteristics were compared between the prolonged and normal LOS groups to screen for the potential predictors of extending LOS after ICH. The outcomes were the proportions of poor outcome at 3 months and 12 months after stroke onset. Poor outcome was defined as an mRS score of 3-5 or death. RESULTS: A total of 1055 mild to moderate ICH patients were enrolled in the study, with 281 (26.6%) exhibiting a LOS of 14 days or less, and 774 (73.4%) exceeding 14 days. The multivariable logistic regression analysis identified several independent predictors of prolonged LOS including younger age, higher annual household income, possession of medical insurance, a history of antithrombotic medication use, infection complication during hospitalization, and hospital regions. Unadjusted analyses showed there were no significant differences in the risk of poor outcome between the prolonged and normal LOS groups at 3 and 12 months after ICH (OR 0.89, 95% CI 0.67-1.17, P = 0.404; OR 0.82, 95% CI 0.61-1.09, P = 0.165). The adjusted models and the sensitivity analysis using propensity score matching and subgroup analysis produced the similar results. CONCLUSIONS: Various factors contributed to prolonged LOS in mild to moderate ICH patients, including younger age, higher annual household income, possession of medical insurance, a history of antithrombotic medication use, the occurrence of infections during hospitalization, and the hospital regions. A prolonged LOS exceeding 14 days was not associated with a better functional outcome for mild to moderate ICH patients at 3 and 12 months.

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