Predictors of prolonged hospital stay in a Comprehensive Stroke Unit.

Abstract:

OBJECTIVE:to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital. METHOD:this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation). RESULTS:353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days). CONCLUSION:this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units. OBJETIVO:analisar as complicações intra-hospitalares de internação prolongada em pacientes com AVC isquêmico ou ataque isquêmico transitório, internados na unidade de AVC de um hospital terciário. MÉTODO:trata-se de um estudo correlacional avaliativo. Todos os pacientes com primeira incidência de acidente vascular cerebral isquêmico ou ataque isquêmico transitório admitidos foram analisados retrospectivamente. Durante a internação hospitalar, os fatores preditores de internação prolongada foram: 1) complicações clínicas (pneumonia, infecção do trato urinário, lesão por pressão e trombose venosa profunda), e 2) complicações neurológicas (acidente vascular cerebral isquêmico maligno e transformação hemorrágica sintomática). RESULTADOS:353 pacientes receberam alta no período do estudo. A média de idade foi de 64,1±13,7 anos e 186 (52,6%) eram homens. O tempo médio de internação hospitalar foi de 13,7±14,3 dias. Pneumonia (25,3±28,8 dias, p<0,001), infecção do trato urinário (32,9±45,2 dias, p<0,001) e acidente vascular cerebral maligno (29,1±21,4 dias, p<0,001) aumentaram significativamente o tempo de permanência hospitalar em relação aos pacientes sem quaisquer complicações (11,2±7,1 dias). CONCLUSÃO:este estudo mostrou que três complicações atrasaram a alta hospitalar em pacientes internados em uma unidade de AVC, duas delas evitáveis: pneumonia e infecção do trato urinário. Medidas mais intensas para evitá-las devem ser incluídas nos indicadores de desempenho para reduzir o tempo de permanência hospitalar nas unidades de AVC. OBJETIVO:Analizar las complicaciones intrahospitalarias de estancia hopitalaria prolongada en pacientes con accidente cerebrovascular isquémico o accidente isquémico transitorio, ingresados en la unidad de accidente cerebrovascular de un hospital terciario. MÉTODO:Se trata de un estudio evaluativo correlacional. Todos los primeros pacientes con accidente cerebrovascular isquémico o ataque isquémico transitorio ingresados fueron analizados retrospectivamente. Durante la estancia hospitalaria, los factores predictivos de hospitalización prolongada considerados fueron: 1) complicaciones clínicas (neumonía, infección del tracto urinario, daño por presión y trombosis venosa profunda), y 2) complicaciones neurológicas (accidente cerebrovascular isquémico maligno y transformación hemorrágica sintomática). RESULTADOS:353 pacientes fueron dados de alta en el período de estudio. La edad media fue de 64,1±13,7 años y 186 (52,6%) eran hombres. El tiempo medio de estancia hospitalaria fue de 13,7±14,3 días. La neumonía (25,3±28,8 días, p<0,001), la infección del tracto urinario (32,9±45,2 días, p<0,001) y el accidente cerebrovascular maligno (29,1±21,4 días, p<0,001) aumentado significativamente la duración de la estancia hospitalaria en comparación con los pacientes sin ninguna complicación (11.2±7.1 días). CONCLUSIÓN:Este estudio mostró que de las tres complicaciones retrasaron el alta hospitalaria en pacientes ingresados en una unidad de accidente cerebrovascular, dos eran prevenibles: la neumonía y la infección del tracto urinario. Las medidas más intensas para evitarlas deben incluirse en los indicadores de rendimiento para reducir la duración de la estancia hospitalaria en unidades de accidente cerebrovascular.

journal_name

Rev Lat Am Enfermagem

authors

Gaspari AP,Cruz EDA,Batista J,Alpendre FT,Zétola V,Lange MC

doi

10.1590/1518-8345.3118.3197

subject

Has Abstract

pub_date

2019-10-14 00:00:00

pages

e3197

eissn

0104-1169

issn

1518-8345

pii

S0104-11692019000100377

journal_volume

27

pub_type

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