COVID-19 length of hospital stay: a systematic review and data synthesis

Rees, E. M. , Nightingale, E. S., Jafari, Y., Waterlow, N. R., Clifford, S., Pearson, C. A.B., CMMID Working Group, ., Jombart, T., Procter, S. R. and Knight, G. M. (2020) COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Medicine, 18, 270. (doi: 10.1186/s12916-020-01726-3) (PMID:32878619) (PMCID:PMC7467845)

Abstract

Background: The COVID-19 pandemic has placed an unprecedented strain on health systems, with rapidly increasing demand for healthcare in hospitals and intensive care units (ICUs) worldwide. As the pandemic escalates, determining the resulting needs for healthcare resources (beds, staff, equipment) has become a key priority for many countries. Projecting future demand requires estimates of how long patients with COVID-19 need different levels of hospital care. Methods: We performed a systematic review of early evidence on length of stay (LoS) of patients with COVID-19 in hospital and in ICU. We subsequently developed a method to generate LoS distributions which combines summary statistics reported in multiple studies, accounting for differences in sample sizes. Applying this approach, we provide distributions for total hospital and ICU LoS from studies in China and elsewhere, for use by the community. Results: We identified 52 studies, the majority from China (46/52). Median hospital LoS ranged from 4 to 53 days within China, and 4 to 21 days outside of China, across 45 studies. ICU LoS was reported by eight studies—four each within and outside China—with median values ranging from 6 to 12 and 4 to 19 days, respectively. Our summary distributions have a median hospital LoS of 14 (IQR 10–19) days for China, compared with 5 (IQR 3–9) days outside of China. For ICU, the summary distributions are more similar (median (IQR) of 8 (5–13) days for China and 7 (4–11) days outside of China). There was a visible difference by discharge status, with patients who were discharged alive having longer LoS than those who died during their admission, but no trend associated with study date. Conclusion: Patients with COVID-19 in China appeared to remain in hospital for longer than elsewhere. This may be explained by differences in criteria for admission and discharge between countries, and different timing within the pandemic. In the absence of local data, the combined summary LoS distributions provided here can be used to model bed demands for contingency planning and then updated, with the novel method presented here, as more studies with aggregated statistics emerge outside China.

• Item Type: Articles
• Additional Information: Funding: EMR receives funding from the Medical Research Council London Intercollegiate Doctoral Training Program (MR/N013638/1). ESN receives funding from the Bill and Melinda Gates Foundation via the SPEAK India Consortium (OPP1183986). YJ receives funding from LSHTM. NRW receives funding from the UK Medical Research Council (MR/N013638/1). SC receives funding from the Wellcome Trust (208812/Z/17/Z). CABP receives funding from Bill and Melinda Gates Foundation NTD Modelling Consortium OPP1184344 and DFID/Wellcome Trust: Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z. TJ receives funding from the UK Public Health Rapid Support Team, NIHR Health Protection Research Unit for Modelling Methodology (HPRU-2012-10096), and the UK Economic and Social Rsearch Council (ES/P010873/1). SRP receives funding from the Bill and Melinda Gates Foundation (OPP1180644). GMK receives funding from the UK Medical Research Council (MR/P014658/1).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Rees, Dr Eleanor
• Authors: Rees, E. M., Nightingale, E. S., Jafari, Y., Waterlow, N. R., Clifford, S., Pearson, C. A.B., CMMID Working Group, ., Jombart, T., Procter, S. R., and Knight, G. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
• Journal Name: BMC Medicine
• Publisher: BioMed Central
• ISSN: 1741-7015
• ISSN (Online): 1741-7015
• Copyright Holders: Copyright © The Author(s). 2020
• First Published: First published in BMC Medicine 18:270
• Publisher Policy: Reproduced under a Creative Commons license