1217 - Associations of Length of Stay with Person- and Hospital-level Factors and Rehabilitation Outcomes after Spinal Cord Injury: Systematic Reviews

Objectives: International incidence data suggest that 250,000 to 500,000 people sustain traumatic and non-traumatic spinal cord injury (SCI) annually. SCI's are costly, resulting from the long length of stay (LOS) in hospitalizations. However, there is limited evidence regarding factors affecting hospital LOS and how variations in LOS are associated with outcomes in people with traumatic or non-traumatic SCI. The purpose of this study was to report our reviews on existing international research literature regarding hospital LOS and how LOS was associated with person- and hospital-level factors and rehabilitation outcomes.

Design: We conducted a literature search from 2009 to March 2023 via electronic databases, including Ovid MEDLINE, Cochrane, CINAHL, and PsycINFO, using keywords from the Medical Subject Headings thesaurus for length of stay, rehabilitation, and spinal cord injury. Final articles were included in the narrative synthesis, with two reviewers extracting study characteristics, factors, definition and quantity of LOS, and results.

Results: Database search identified 9864 records. We used Covidence to yield 7357 unique records. Among all included articles, the average rehabilitation LOS in Australia, Canada, and China were 2-3 times longer than in the United States. Older age, complete tetraplegia, and obesity were associated with longer LOS. Earlier studies often reported shorter LOS was associated with favorable outcomes, including higher discharge functional status, mobility, discharge to home, availability of social support, and low re-hospitalization rates. However, most of these studies did not adjust for neurologic injury characteristics. In contrast, recent studies adjusted for neurologic categories found that longer LOS was associated with improved motor function.

Conclusions: The study has revealed inconsistent results regarding LOS and outcomes in SCI rehabilitation. We are limited by the modifying factors that impact LOS, which our current meta-analysis will aid. Future studies should use a mixed-methods approach to understand the outcomes of people with SCI and consider global policy implications.