Influential Factors on the Hospitalization Length of COVID-19 patients: A Systematic Review

The COVID-19 pandemic has led to rising demand for hospital beds and the shortage of medical equipment and supplies. It is necessary to identify the factors that influence the length of stay of COVID-19 patients to accurately predict the number of beds needed at each level of care. This study systematically reviewed influential factors on the hospitalization of COVID-19 patients to provide evidence for risk classification and improvement of clinical outcomes and recommendation solutions for reducing the length of stay.

With the appropriate keywords and a clearly defined search strategy, relevant databases such as PubMed, Embase, and Cochrane Library were searched for cohort studies and randomized control trials to November 10, 2020. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of studies. Data including influencing factors length of stay, age, sex, country were extracted based on a checklist developed by the researchers. Data obtained due to differences in measurement criteria were qualitatively analyzed.

The systematic search resulted in 48 relevant studies.  Dependence of the severity of disease on age and comorbidities is the principal determinant of increased length of stay. Secondary bacterial infections, obesity, diabetes, and uncontrolled hyperglycemia in COVID-19 patients are likely to increase their length of stay. Special attention to liver damage has also been recommended in SARS-CoV-2 infections since pharmacological factors are independent risk factors for liver damage in non-severe patients. Neurological complications at presentation or during the hospital stay significantly increase the risk of prolonged hospitalization. Shortage of re-sources could decrease stay among COVID-19 patients, which indicates that intensive care is either delayed, deferred, or abbreviated.

Overall, demographic and epidemiological factors, dietary factors and diabetes, neurological conditions, liver damage, acute cardiovascular diseases, and social factors contribute to the length of hospital stay in COVID-19 patients. The present results can provide insights for policymakers regarding the factors that influence the length of stay of COVID-19 patients and practical solutions that can be employed to manage these factors.