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Am J Psychiatry 1991; 148:324-329
Copyright © 1991 by American Psychiatric Association
Psychological comorbidity and length of stay in the general hospital
SM Saravay, MD Steinberg, B Weinschel, S Pollack and N Alovis
Long Island Jewish Medical Center, New Hyde Park, NY 11042.
OBJECTIVE: As general hospitals search for ways to cut costs without
sacrificing efficiency, particular attention has been focused on factors
that may prolong hospital stay. The results of prior studies that have
reported an association between psychological and psychiatric comorbidity
and longer hospital stays have been subject to different interpretations
because of methodological design flaws. The current paper reports on a
study of psychological comorbidity and length of stay that has been
designed to avoid the methodological problems of earlier investigations.
METHOD: The study was performed at a 429-bed tertiary-care,
university-affiliated, voluntary, teaching hospital. During hospital days 3
to 5, patients were tested as available with the Mini-Mental State
examination, the Zung Depression Inventory, and the SCL-90 and were rated
for physical impairment with the Karnofsky Performance Status Scale.
Statistical analyses were performed for correlations between length of stay
and test scores, rating scales, and demographic and discharge data from the
chart. RESULTS: Of 424 patients approached, 321 (76%) agreed to participate
and 278 (65.6%) completed the test battery. Depression, anxiety, and
organicity, measured by psychological tests, were significantly correlated
with longer hospital stay. These correlations remained significant after
the authors controlled for degree of physical impairment, emergency versus
elective admission, and medical versus surgical service, which were
themselves correlated with longer hospital stay. DISCUSSION: This study
confirms a significant correlation between psychological comorbidity and
length of stay after correcting for the methodological pitfalls found in
earlier studies. The clinical, research, economic, and policy implications
of these findings are discussed.
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