Length of Hospital Stay

Definition
Description
Average Length of Hospital Stay

Definition

The length of time a patient is required to stay overnight in the hospital is determined by their medical condition.

Description

The length of time a patient needs to stay in the hospital depends upon what type of care they require, how sick they are, and whether they need medications that cannot be administered at home. According to the United States Centers for Disease Control and Prevention (CDC), the average length of hospital stay statistically increases with age.

Conditions that May Require a Length of Hospital Stay

• Very High Fever
• Significantly Altered Vital Signs – Pulse, Blood Pressure, Breathing Rate, Temperature
• Severe Alterations in the Heartbeat
• Major Trauma - Injuries including Burns, Lacerations, and other Trauma
• Organ Failure
• Need for Intravenous (IV) Medications
• Psychotic Episodes
• Being Homicidal or Suicidal
• Recovery from Surgery
• Complications from Surgery
• Severe Allergic Reactions
• Severe Adverse Effects of Medications
• Drug-induced Delirium
• Severe Infections – Bacterial, Fungal, or Viral
• Inability to Breathe
• Inability to Urinate
• Chemical Toxicity from Poison
• Radiation Sickness
• Debilitating Diseases

Length of Hospital Stay after Surgery

Whether or not a hospital stay is necessary after surgery depends on the type of surgical procedure and whether there are any medical complications. More invasive surgical procedures often require longer hospital stays than minimally invasive procedures. Patients may require a specific time period of hospital-based rest and recovery if their post-surgical medical condition is serious enough to warrant the supervision of a doctor. Post-surgical complications may require a length of hospital stay until they can be resolved, which may or may not include several overnight stays.

The presence of a fever after surgery may necessitate a length of time staying in the hospital. Fever may be a sign of surgically related systemic infection that could become life threatening. If the operative site is very swollen or showing other signs of local

infection, the patient may need to remain in the hospital. Operative sites that are still bleeding may also be cause to stay in the hospital. Generally speaking, a patient may be required to be able to think clearly, remain upright without fainting, drink fluids and consume light food without vomiting, breathe normally, urinate normally, be able to walk, and be free of severe pain before they are allowed to leave the hospital after a surgical procedure.

After a surgical procedure requiring general anesthesia, a patient is required to be awake and able to think clearly before they are discharged from the hospital. While many patients may experience some feelings of mental confusion after having general anesthesia, staying overnight is only necessary if the mental state has deteriorated beyond normal responses to anesthesia, such as seen with postoperative delirium. Delirium is a severe state of mental confusion, disorientation, agitation, and general incoherence. Delirium may also include hallucinations. Postoperative delirium is a temporary state of delirium that may be caused by multiple factors relating to the surgical procedure. A postoperative temporary state of delirium may occur if the patient experiences a lack of oxygen, hypotension, or sepsis as a result of the surgical procedure. With proper treatment, post-operative delirium usually only requires a hospital stay of about 72 hours.

If a patient is unable to keep down fluids or food, the length of hospital stay necessary after surgery is increased. The patient will need fluids through an IV route to remain hydrated until they may hydrate themselves by drinking fluids. Similarly, a patient who cannot keep down food after surgery may require a feeding tube for nourishment. Many patients may experience vomiting merely as an after effect of general anesthesia. In this case, problems with vomiting usually resolve themselves within hours and the length of hospital stay after surgery may be very short.

If there are complications with the patient’s ability to breathe after a surgical procedure, a hospital stay will be necessary until the issue is resolved. In this case, a breathing tube and respirator is medically necessary and the length of stay is determined by whatever condition is causing the breathing problem. The ability to urinate after surgery can be affected by certain types of anesthesia used during the procedure. Anesthesia-based urinary retention may require a hospital stay that ranges from hours to several days before it is resolved. Additionally, some types of surgery may cause serious problems with the kidneys that first show up as urinary retention. Patients must be able to urinate before being allowed to go home.

Because patients must be generally well and on the road to recovery after surgical procedures, length of hospital stay is affected by a patient’s ability to walk. Surgery is often associated with postoperative pain and some fatigue that greatly limits activity level. An activity level that is too high can also cause internal bleeding at surgical sites, and so bed rest is often encouraged. However, most patients should be able to walk short distances, such as to the bathroom, or they may require a hospital stay.

Severe pain is also associated with increased length of hospital stay after surgery. Often, if the pain is very severe, an IV form of morphine is used in the hospital. Additionally, severe pain after surgery may be an indication that something is wrong, or a surgical complication has occurred. Until severe pain is resolved and there are no apparent surgical complications, patients may be required to stay in the hospital.

Length of Hospital Stay after Childbirth

Childbirth can cause significant physical trauma to a woman’s body. Even without medical complications, the act of birthing takes a significant physical toll that usually requires a length of hospital stay. Usually, a normal vaginal birth with no complications results in a hospital stay that ranges from one to four days. When childbirth causes tearing of the skin or muscle around the vagina and surrounding area, it may create the need for a longer hospital stay. The more severe the tearing, the more likely it will need a longer stay for treatment and healing. Very severe tearing involving the rectum or post-tear infections may require the longest hospital length of stay. Childbirth done by caesarean delivery is performed through a surgical incision in the abdominal wall as well as the wall of the uterus. This method of childbirth is associated with the greatest length of hospital stay, usually from four to nine days. Infection of the incision site increases length of stay.

KEY TERMS

Caesarean Delivery— Childbirth performed through a surgical incision in the abdominal wall as well as the wall of the uterus, as opposed to normal vaginal delivery.

Delirium— An altered state of consciousness that includes confusion, disorientation, incoherence, agitation, and defective perception (such as hallucinations).

Laceration— A ragged wound.

Malignant Neoplasm— Any malignant cancerous growth or tumor caused by uncontrolled cell division and capable of spreading to other parts of the body than where it formed.

Morphine— A very strong painkiller often used post-surgically.

Pneumonia— An inflammatory lung disease that affects the ability of the respiratory system to function.

Vital Signs— The physiological aspects of body function basic to life. They are temperature, pulse, breathing rate, and blood pressure.

Average Length of Hospital Stay

Research done by the CDC determined the average length of short-term hospital stay for various medical conditions in 2005. The categories studied were diverse, ranging from psychiatric disorders to heart disease and injuries. The length of hospital stay in the categories studied was longest for psychiatric disorders, which had an average of eight days. One of the shortest lengths of hospital stay was for childbirth, which averaged 2.6 days. In 2005, the following were some of the medical conditions that averaged between four and six days length of hospital stay: heart disease, bone fractures, diabetes, urinary tract infections, and pneumonia. Malignant neoplasms (cancer) had an average length of short-term hospital stay that ranged between seven and nine days. These specific categories of disease were chosen for the study because in 2005 they were responsible for millions of hospital discharges.

Resources

BOOKS

Beers, Mark H. “Surgery.” In The Merck Manual of Medical Information: 2nd Home Edition. Whitehouse Station, NJ: Merck & Co., 2004. Also available online at http://www.merck.com/mmhe/sec25/ch301/ch301a.html [Accessed April 10, 2008].

OTHER

CDC Vital and Health Statistics. National Hospital Discharge Survey: Advance Data 2005. Number 385, July 2007. http://www.cdc.gov/nchs/data/ad/ad385.pdf

CDC Vital and Health Statistics. National Hospital Discharge Survey: 2005 Annual Summary with Detailed Diagnosis and Procedure Data. Series 13, Number 165, December 2007. http://www.cdc.gov/nchs/data/series/sr_13/sr13_165.pdf

“Episiotomy.” Medicine Net. http://www.medicinenet.com/episiotomy/article.htm [Accessed April 10, 2008].

Sehdev, Harish M. “Cesarean Delivery.” Emedicine. August 6, 2005. http://www.emedicine.com/MED/topic3283.htm [Accessed April 10, 2008].

Maria Basile, PhD

Ligation for varicose veins seeVein ligation and stripping