title: Hospital length of stay in patients with non-ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Substantial heterogeneity in hospital length of stay exists among patients admitted with non-ST-segment elevation myocardial infarction. Furthermore, little is known about the factors that impact length of stay.
  
  
  METHODS
  We examined 39,107 non-ST-segment elevation myocardial infarction patients admitted to 351 Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines hospitals from January 1, 2007-March 31, 2009 who underwent cardiac catheterization and survived to discharge. Length of stay was categorized into 4 groups (≤2, 3-4, 5-7, and ≥8 days), where prolonged length of stay was defined as >4 days.
  
  
  RESULTS
  The overall median (25(th), 75(th)) length of stay was 3 (2, 5) days. Patients with a length of stay of >2 days were older with more comorbidities, but were less likely to receive evidence-based therapies or percutaneous coronary intervention. Among the factors associated with prolonged length of stay >4 days were delay to cardiac catheterization >48 hours, heart failure or shock on admission, female sex, insurance type, and admission to the hospital on a Friday afternoon or evening. Hospital characteristics such as academic versus nonacademic or urban versus rural setting, were not associated with prolonged length of stay.
  
  
  CONCLUSIONS
  Patients with longer length of stay have more comorbidities and in-hospital complications, yet paradoxically, are less often treated with evidence-based medications and are less likely to receive percutaneous coronary intervention. Hospital admission on a Friday afternoon or evening and delays to catheterization appear to significantly impact length of stay. A better understanding of factors associated with length of stay in patients with non-ST-segment elevation myocardial infarction is needed to promote safe and early discharge in an era of increasingly restrictive health care resources.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27705, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Vavalle
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D011183:Postoperative Complications; D012042:Registries; D012307:Risk Factors; D014481:United States