Factors Associated With Prolonged Length of Stay in Adult Clinical Admissions: A Retrospective Cohort Study

Background Hospital admissions account for a substantial proportion of healthcare expenditure, motivating the study of factors associated with extended hospitalization and resource use. Routine clinical and care complexity information may be relevant to discharge planning, but whether incorporating these measures into clinical workflows improves patient or service outcomes requires prospective evaluation. Objective To examine the associations of early clinical and functional measures and events occurring during hospitalization with prolonged length of stay among adult clinical admissions to a public university hospital, including the contributions of two structured assessment instruments. Methods This retrospective cohort study analysed 250 clinical admissions at a Brazilian university hospital. Prolonged length of stay was defined according to Brazilian Unified Health System criteria. Associations between the Blaylock Risk Assessment Screening Score, Fugulin Scale, and prolonged length of stay were examined using simple and multivariable logistic regression. Apparent model discrimination was assessed using receiver operating characteristic analysis; no internal validation was performed. Results Prolonged length of stay occurred in 39.6% of admissions. Among these, excess days beyond expected length of stay represented 30% of all bed days. The Fugulin Scale remained associated with prolonged length of stay in the adjusted model (odds ratio = 1.14; 95% confidence interval, 1.05–1.25), whereas the Blaylock Risk Assessment Screening Score was no longer significant after adjustment ( p = 0.390). Intensive care unit admission and genitourinary diagnoses were also associated with prolonged length of stay (odds ratios of 2.85 and 6.08, respectively). Healthcare‐associated infections were recorded in only 11 admissions; although their adjusted odds ratio was 7.10, the wide 95% confidence interval (1.22–41.22) indicates substantial uncertainty. The model had an area under the curve of 0.783 and a Nagelkerke R 2 of 0.307. Because intensive care unit admission and healthcare‐associated infections may occur after the initial assessment, these performance estimates do not represent admission‐time prediction. Conclusion The Fugulin Scale score was associated with prolonged length of stay in this retrospective analysis, while intensive care unit admission and healthcare‐associated infections reflected events in the evolving hospital course. Whether using the Fugulin Scale improves prediction, discharge planning, or resource allocation requires prospective evaluation. The combined model should not be used as an admission‐time prediction tool.