Trends in Prolonged Hospitalizations in the United States from 2001 to 2012: A Longitudinal Cohort Study

Health policy debate commonly focuses on frequently hospitalized patients, but less research has examined trends in long-stay patients, despite their high cost, effect on availability of hospital beds, and physical and financial implications for patients and hospitals.

Using the National Inpatient Sample, a nationally representative sample of acute care hospitalizations in the US, we examined trends in long-stay hospitalizations from 2001-2012. We defined long stays as those 21 days or longer and evaluated characteristics and outcomes of those hospitalizations, including discharge disposition and length of stay and trends in hospital characteristics. We excluded patients under 18 years of age and those with primary psychiatry, obstetric, or rehabilitation diagnoses, and weighted estimates to the US population.

Prolonged hospitalizations represented only 2% of hospitalizations, but approximately 14% of hospital days and incurred estimated charges of over $20 billion dollars annually. Over time, patients with prolonged hospitalizations were increasingly younger, male, and of minority status, and these hospitalizations occurred more frequently in urban, academic hospitals. In-hospital mortality for patients with prolonged stays progressively decreased over the 10-year period from 14.5% to 11.6% (P <.001 for trend in grouped years), even accounting for changes in demographics and comorbidity.

The profile of patients with prolonged hospitalizations in the US has changed, although their impact remains large, as they continue to represent 1 of every 7 hospital days. Their large number of hospital days and expense increasingly falls upon urban academic medical centers, which will need to adapt to this vulnerable patient population.