BACKGROUND Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.

中文翻译：

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神经外科患者群体中超出医疗准备状态的住院时间和相关的医疗保健费用

背景 超出医疗准备时间的住院时间 (LOS-BMR) 会导致与医院获得性疾病相关的费用增加和发病率增加。目的 确定有 LOS-BMR 和相关危险因素和费用的入院神经外科患者的比例。方法 我们对入院超过 5 个月的所有神经外科患者进行了前瞻性队列分析。LOS-BMR 每天由主治神经外科医生和神经重症监护医师根据标准化标准进行评估。进行了单变量和多变量逻辑回归。结果 在入院的 884 名患者中，229 名 (25.9%) 有 LOS-BMR。平均 LOS-BMR 为 2.7 ± 3.1 天，平均每日成本为 9 148.28 美元 ± 12 983.10 美元，这导致 5 个月期间的总成本为 2 076 659.32 美元。患有 LOS-BMR 的患者更可能年龄较大，并且患有偏瘫、痴呆、肝病、肾病和糖尿病。LOS-BMR 患者出院到亚急性康复/专业护理机构（40.2% 对 4.1%）或急性/住院康复机构（22.7% 对 1.7%，P < .0001）的可能性明显更高。有医疗保险的患者更有可能有 LOS-BMR，而有私人保险的患者则不太可能 (P = .048)。结论 LOS-BMR 的最常见原因是由于出院地点床位不可用、保险清关延迟和家庭相关问题导致患者出院到康复和护理机构的效率低下。LOS-BMR 患者出院到亚急性康复/专业护理机构（40.2% 对 4.1%）或急性/住院康复机构（22.7% 对 1.7%，P < .0001）的可能性明显更高。有医疗保险的患者更有可能有 LOS-BMR，而有私人保险的患者则不太可能 (P = .048)。结论 LOS-BMR 的最常见原因是由于出院地点床位不可用、保险清关延迟和家庭相关问题导致患者出院到康复和护理机构的效率低下。LOS-BMR 患者出院到亚急性康复/专业护理机构（40.2% 对 4.1%）或急性/住院康复机构（22.7% 对 1.7%，P < .0001）的可能性明显更高。有医疗保险的患者更有可能有 LOS-BMR，而有私人保险的患者则不太可能 (P = .048)。结论 LOS-BMR 最常见的原因是由于出院地点没有床位、保险清关延迟和家庭相关问题而导致患者出院到康复和护理机构的效率低下。有医疗保险的患者更有可能有 LOS-BMR，而有私人保险的患者则不太可能 (P = .048)。结论 LOS-BMR 的最常见原因是由于出院地点床位不可用、保险清关延迟和家庭相关问题导致患者出院到康复和护理机构的效率低下。有医疗保险的患者更有可能有 LOS-BMR，而有私人保险的患者则不太可能 (P = .048)。结论 LOS-BMR 的最常见原因是由于出院地点床位不可用、保险清关延迟和家庭相关问题导致患者出院到康复和护理机构的效率低下。