Neurosurgery Resident (PGY-5) University of California San Francisco Daly City, California, United States
Introduction: Hospital length of stay (HLOS) is an important metric of injury severity, resource utilization, and access to services. Risk factors for prolonged HLOS after traumatic brain injury (TBI) are poorly understood.
Methods: Adult inpatients admitted to a single U.S. Level 1 trauma center diagnosed with acute TBI between 08/01/2019-04/01/2022 were analyzed. HLOS was stratified by percentiles (Tier 1: 0-74th percentile; 2: 75-84th; 3: 85-94th; 4: 95-99th). Socioeconomic, clinical, and discharge factors were compared across tiers. Cost analysis was performed for medically-stable inpatients with Tier 4 HLOS awaiting discharge to post-acute facility. Statistical significance was assessed at p< 0.05.
Results: In 1,557 patients, median HLOS was 4 days (range 0-145); HLOS tier ranges were 0-7, 8-13, 14-27, and ≥28 days, respectively. The proportion of severe TBI patients (assessed by Glasgow Coma Scale) increased with HLOS (Tier 1: 9%; 2: 13%; 3: 21%; 4: 41%; p< 0.001), as did the proportion of patients discharged to post-acute facility (11%; 32%; 33%; 55%, respectively; p< 0.001). Tier 4 HLOS differed from shorter tiers by age (≥80-years: 6% vs. 23-25%), sex (male: 83% vs. 68-73%), race (Hispanic: 36% vs. 21-22%), socioeconomic status (SES; low: 54% vs. 31-33%), and Medicaid insurance (54% vs. 29-32%). When stratified by TBI severity, these effects were driven by severe TBI patients, in whom Tier 4 HLOS was associated with decreased proportions of age ≥80-years (0% vs. 8-22%), increased proportions of low SES (79% vs. 29-35%) and Medicaid (78% vs. 27-38%). Estimated daily cost for a medically-stable inpatient was $17,836.
Conclusion : Severe TBI patients are more likely to have Medicaid, decreased socioeconomic resources, and increased risk of prolonged HLOS. Medically-stable inpatients awaiting placement accrue immense daily and cumulative healthcare costs. Policy updates are critically needed to improve access to post-acute services for TBI patients.
