Factors Associated With Prolonged Length of Stay in Patients Hospitalized With Generalized Convulsive Status Epilepticus in the United States

Objective: Generalized convulsive status epilepticus (GCSE) is a severe complication of epilepsy, which typically requires extended hospitalization, resulting in substantial resource utilization, hospital expenditures, and patient costs. In this nationwide analysis, we examined hospital length of stay (LOS) patterns for GCSE, and the factors that influence prolonged LOS. Methods: We extracted data for adult patients (age 18 years and above) with a primary discharge diagnosis of GCSE from the National Inpatient Sample (NIS) from 2006-2014, the largest all-payer inpatient care database in the United States. We computed LOS (≤1, 2-6, and ≥7 days), overall, and across pre-specified patient-related, hospital-related, and healthcare system-related variables available in the NIS. We identified factors independently associated with prolonged hospitalization (2 or more days), using a multivariable logistic regression model. Results: Of 57,832 discharged with a primary diagnosis of GCSE, 6,133 (10.7%) had a LOS ≤1 day, 27,327 (7.3%) stayed for 2-6 days, and 24,372 (42.1%) stayed for ≥7 days. After adjusting for confounders, patients who were older, female, Black, and Hispanic, who underwent continuous EEG video monitoring, were Medicare beneficiaries, had medical comorbidities, or were admitted to large/urban hospitals, were all significantly more likely to have prolonged LOS. Conclusion: Over 40% of patients hospitalized for GCSE in the United States spend at least a week in the hospital. Efforts to shorten hospitalization for GCSE may need to primarily focus on patient groups with select sociodemographic and clinical characteristics.