Factors Affecting Hospitalization and Length of Hospitalization of the Patients with Covid-19
Authors: Jalilvand Hadi , Abdi Mojtaba , Hejazi Zadeh Niloofar , Jalilvand Alireza , Pourrahimi Matineh , Pirzadeh Fatemeh , Haghi Fatemeh , Abo Aljadayel Doha 
Published: April 2022

Background and Objectives Although a significant number of Covid-19 patients tend to be hospitalized, few studies have explored the factors related to the hospitalization of these patients. This study was conducted to investigate the factors affecting the hospitalization and duration of hospitalization of the patients with Covid-19 in Shohada Imam Hossein Hospital in Tehran in the first half of 2020. \ Material and Methods This cross-sectional study was performed by convenience sampling method. Data were collected using a two-part researcher-made checklist. The checklist was sent to 15 specialists in the fields of epidemiology, nursing, statistics and general practitioners to check the content validity. Content validity index (CVI) and content validity ratio (CVR) were used to check the validity of the content of the checklist and Cronbach's alpha index was used to assess the reliability. To investigate the relationship between the studied variables, independent t-test, t-test, one-way analysis of variance, Spearman and Pearson test were used at a significance level of 0.05. Results The Cronbach's alpha index of the study checklist was equal to (r = 0.824). The total values of the CVI and CVR index for the whole checklist were found to be 0.870 and 0.733respectively.Therefore, it can be claimed that the checklist used in this study an acceptable level of content validity. 291 patients participated in this study. The mean and standard deviation of the length of hospital stay was 7.59 ± 4.14 days. There was a significant relationship between total length of hospital stay and each of the following variables: history of renal impairment (P-value = 0.034), presence of symptoms of shortness of breath (P-value = 0.007), nausea (P-value = 0.016), oxygen therapy (P-value = 0.022), use of Apotel (P-value = 0.045), use of Kaltera (P-value = 0.020), and hydroxychloroquine use (P-value = 0.022). Conclusion Symptoms of dyspnea, age, and oxygen therapy were the most important factors influencing the length of hospital stay. Thus, physicians and nurses should prioritize the use of oxygen therapy for patients, especially the elderly ones with the symptoms of dyspnea, in order to accelerate the recovery of the patients, and consequently reduce the duration of hospitalization. Extended Abstract Background and Objectives Covid-19 is an emerging disease that has quickly become a global problem, spreading to every country and becoming a pandemic. A significant number of Covid-19 patients are hospitalized. Few studies have studied the factors related to the hospitalization of these patients. This study was conducted to investigate the factors affecting the hospitalization and duration of hospitalization of the patients with Covid-19 in Shohada Imam Hossein Hospital in Tehran in the first half of 2020. Material and Methods This cross-sectional study was completed by convenience samplingmethod. Data were collected using a researcher-made two-part checklist. Demographic information and underlying diseases part included gender with two female and male options, quantitative and crude age, one 13-choice question and 5 two-choice yes or no questions. The other part, information on Covid-19 disease status of the participants, consisted of a 3-choice question, 5 yes or no questions, a 9-choice question, and 6 open-ended questions. Content validity index (CVI) and content validity ratio (CVR) were used to check the validity of the content of the checklist and Cronbach's alpha index was used to assess the reliability. To investigate the relationship between the studied variables, independent t-test, t-test, one-way analysis of variance, Spearman and Pearson test were employed at a significance level of 0.05. Results The value of Cronbach's alpha calculating the reliability of the checklist was equal to (r = 0.824). The total value of the CVI index for the whole checklist was equal to 0.870 and the value of the total CVR index of the total checklist was calculated to be 0.733, so the content validity of the checklist was established. 291 patients participated in this study, 150 of whom (51.50%) were female. The mean and standard deviation of the participants’ age in this study was 58.81 ± 18.75., 51 (17.52%) patients had to stay in intensive care unit (ICU) all or part of their hospital stay. Oxygen therapy was performed for 162 patients (55.67%) and the mean and standard deviation of oxygen therapy was 4.73 ± 42 2.42 liters per minute. 9 patients (3.09%) were intubated during their hospitalization. The most common symptom of Covid-19 disease was a cough in 144 patients (49.48%). The most commonly used drugs for the treatment of patients were hydroxychloroquine 225 (77.32%)), naproxen (199 (68.38%) and cefotaxime (106 (36.43%)). The mean and standard deviation of the length of hospital stay was 7.59 ± 4.14 days. There was a significant relationship between the history of renal impairment (P-value = 0.034), the presence of symptoms of shortness of breath (P-value = 0.007), nausea (P-value = 0.016), oxygen therapy (P-value = 0.022), use of Apotel (P-value = 0.045), use of Kaltera (P-value = 0.020), use of hydroxychloroquine (P-value = 0.022) and the total length of hospital stay. There was a very weak positive correlation (r = 0.061) between the length of hospital stay in the intensive care unit and the age of the patients, which was not significant (P-value = 0.718). There was a significant relationship between age and the final outcome of the disease in patients (P-value = 0.013). Conclusion Since hydroxychloroquine and azithromycin therapies are not usually important factors in the treatment of patients with Covid-19, their effect was only marginal on the period of hospitalization and consequently these drugs cannot be considered as factors determining the duration of hospitalization. Symptoms of dyspnea, age, and oxygen therapy were the most important factors influencing the length of hospital stay. Thus, physicians and nurses should prioritize the use of oxygen therapy for patients, especially the elderly ones with the symptoms of dyspnea, in order to accelerate the recovery of the patients, and consequently reduce the duration of hospitalization. Practical Implications of Research According to the results of this study, we suggest that physicians and nurses use more oxygen therapy to treat patients to accelerate the recovery of these patients, reduce the length of hospital stay, and ultimately to reduce health care costs. Oxygen therapy is the most important practical measure in reducing the length of hospital stay of patients. Ethical Considerations The patients signed informed consent forms and the information was collected anonymously without being returned to the person. In addition, each patient could leave the study if they wanted to, or not answer the questions, without any consequences for them due to their withdrawal. Conflict of Interest We hereby declare that we have no conflict of interest in conducting this study with any organization, natural person or legal entity. Aknowledgment We would like to thank the nurses of Imam Hossein Shohada Hospital in Tehran, the patients who participated in this study and all those who helped us in doing this research study. This study is a continuation of a research project with ethics code number IR.IUMS.FMD.REC.1399.323 and supported by Iran University of Medical Sciences.