gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Factors related to prolonged length of acute care stay of patients with spontaneous intracerebral hemorrhage

Meeting Abstract

  • Marco Stein - Klinik für Neurochirurgie, Justus-Liebig Universität, Gießen, Germany
  • Björn Misselwitz - Institut für Qualitätssicherung Hessen, Eschborn, Germany
  • Gerhard F. Hamann - Klinik für Neurologie und Neurologische Rehabilitation, Bezirkskrankenhaus Günzburg, Germany
  • Malgorzata A. Kolodziej - Klinik für Neurochirurgie, Justus-Liebig Universität, Gießen, Germany
  • Marcus H. T. Reinges - Klinik für Neurochirurgie, Justus-Liebig Universität, Gießen, Germany
  • Eberhard Uhl - Klinik für Neurochirurgie, Justus-Liebig Universität, Gießen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.05.02

doi: 10.3205/16dgnc259, urn:nbn:de:0183-16dgnc2592

Veröffentlicht: 8. Juni 2016

© 2016 Stein et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Prolonged length of stay (LOS) of surgically and conservatively treated patients with spontaneous intracerebral hemorrhage (ICH) is an important cost driver during acute care stay. Currently no clear definition of prolonged LOS for surgically and conservatively treated patients with ICH exists. The purpose of this study was to define change-points for LOS and to identify factors that are associated with the risk of prolonged LOS.

Method: For this analysis we used a state wide quality assessment registry for stroke patients in central Germany. Using cumulative sum control chart (CUSUM) analysis, we calculated different change points in LOS during acute care for surgically and conservatively treated patients with ICH. The confidence intervals (CI) and the confidence levels (CL) for these change points were calculated. The influence of several comorbidities, baseline characteristics at admission and in-hospital complications were evaluated in a multivariate model.

Results: Overall, 13.272 patients with ICH were included in our analysis. Surgical therapy of the hematoma was documented in 1.405 (10.6%) patients. The median LOS was shorter for conservatively treated patients compared to surgically treated patients (9 days, IQR: 3-14 days, versus 15 days, IQR: 8 -23 days; P < 0.001). Using CUSUM analysis identified change points for LOS were 16 days (CI: 16, 16; CL: 99%) for conservatively treated patients and 22 days (CI: 8, 22; CL 98%) for surgically treated patients. Ventilation therapy was documented in 3438 patients (25.9%). Ventilation therapy was associated with prolonged LOS in both conservatively treated patients (OR: 2.5, 95% CI: 2.2-2.9; P<0.001) and surgically treated patients (OR: 2.2, 95% CI: 1.5-3.1; P<0.001). An accumulation of ≥2 secondary complications during the acute care stay was associated with a higher risk of prolonged LOS in conservatively treated patients (OR: 3.0, 95% CI: 2.7-3.3), and in surgically treated patients (OR: 2.7, 95% CI: 2.1-3.5).

Conclusions: For the first time change-points for LOS after intracerebral hemorrhage during acute care were identified for conservatively and surgically treated patients. Patients with ventilation therapy and an accumulation of secondary complications during the acute care stay are high risk candidates for prolonged LOS.