title: Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study.
abstract: OBJECTIVE
  To characterize medical and nonmedical reasons for delayed discharge on a general thoracic surgery unit.
  
  
  METHODS
  A prospective observational cohort study.
  
  
  METHODS
  A university-affiliated tertiary care institution.
  
  
  METHODS
  Between February 1999 and July 2000, the in-hospital progress of 130 patients who had undergone an elective thoracic surgical procedure was evaluated prospectively. Baseline characteristics (age, sex, comorbid conditions and pulmonary function test results) were documented.
  
  
  METHODS
  Complications that delayed the time when the patient was medically ready for discharge. The day the patient was deemed fit for discharge (medically required length of stay) was compared with the actual day of discharge (actual length of stay).
  
  
  RESULTS
  The 3 most frequent complications that prevented discharge by postoperative day 6 were persistent air leaks, pulmonary infections and atrial fibrillation. The presence of a persistent air leak increased the medically required length of stay by a mean of 13.1 days (95% confidence interval [CI] 11.0-15.2 d), pneumonia by 9.6 days (95% CI 4.96-14.2 d) and atrial fibrillation by 2.4 days (95% CI -2.6 to 7.4 d). The mean medically required length of stay was 6.9 days, and this differed from the mean day on which the patient was actually discharged (7.35 d, p < 0.01), which contributed 44 excess days of hospitalization per 100 patients. The 2 most common causes of this discrepancy were the lack of home support (10.2% of patients) and the unavailability of convalescent facilities (7.1% of patients). Prolonged hospital stay for nonmedical reasons was associated with increased mean age (67.4 v. 60.7 yr, p = 0.05).
  
  
  CONCLUSIONS
  Length of hospitalization after elective thoracic surgery may be prolonged for medical or nonmedical reasons. Although complications like persistent air leak and pneumonia have an impact on medically required length of stay, social factors may also significantly delay discharge.
authors.affiliation: Department of Surgery, McGill University, Montreal, Que.
authors.forename: Kashif
authors.initials: K
authors.lastname: Irshad
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.forename: Victor F
authors.initials: VF
authors.lastname: Chu
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dorval
authors.forename: Ghassan
authors.initials: G
authors.lastname: Baslaim
authors.forename: Jean E
authors.initials: JE
authors.lastname: Morin
mesh_terms: D000359:Aftercare; D001281:Atrial Fibrillation / Q000453:epidemiology; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006302:Health Services Research; D006699:Home Care Services / Q000600:supply & distribution; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D014600:Utilization Review