Table 1 Summary study characteristics of included studies (n=52). A total of 46 studies were identified from China, and 6 studies identified outside of China
From: COVID-19 length of hospital stay: a systematic review and data synthesis
Author | Publication date | Status | Study dates | Country | Province/ region | Study population | Study design | Sample size LOS | Sex (% male) | Age | Follow-up completed | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Bhatraju et al. [34] | 30 March 2020 | Published | 24 February 2020–09 March 2020 | USA | Seattle, WA | Patients with laboratory-confirmed COVID-19 infection who were admitted to nine hospital ICUs in the Seattle region | Cohort | 24 | 63 | 64 ± 18** | No | Not all patients in this study were discharged. Once discharged from ICU, several patients were transferred to ward. |
Cai et al. [60] | 02 April 2020 | Published | 11 January 2020–06 February 2020 | China | Shenzhen, Guangdong | Patients with confirmed COVID-19 admitted to the Third People’s Hospital of Shenzhen | Cohort | 298 | 48.66 | 47.5 (33–61)* | No | Patients remained hospitalised at the end of the study. It was unclear whether LOS was reported for only dead/discharged patients or also included still-hospitalised patients. |
Cao et al. [61] | 18 March 2020 | Published | 18 January 2020–03 February 2020 | China | Wuhan, Hubei | Laboratory-confirmed COVID-19 patients admitted to Jin Yin-Tan Hospital | RCT | 199 | 60.3 | 58 (49–68)* | No | Patients still hospitalised at the end of the study. Not clear on the number of deaths. |
Cao et al. [62] | 02 April 2020 | Published | 03 January 2020–15 February 2020 | China | Wuhan, Hubei | All lab-confirmed patients with COVID-19 admitted to Wuhan University Zhongnan Hospital | Cohort | 102 | 52 | 54 (37–67)* | Yes |  |
Chen et al. [63] | 11 March 2020 | Published | 20 January 2020–25 February 2020 | China | Shanghai | Recruited patients admitted to Shanghai Public Health Clinical Center (SPHCC), diagnosed with COVID-19 according to Chinese national guideline for COVID-19 diagnosis and treatment, as well as the World Health Organization interim guidance. | Cohort | 215 | 50.6 | 51 (36–64)* | No | Not all patients in this study were discharged. |
Chen et al. [64] | 26 March 2020 | Published | 13 January 2020–28 February 2020 | China | Wuhan, Hubei | All COVID-19 confirmed patients admitted to Tongji Hospital | Cohort | 274 | 62.4 | 62.0 (44.0–70.0)* | No | Patients still hospitalised at the end of the study. |
Chen et al. [65] | 06 March 2020 | Published | 23 January 2020–20 February 2020 | China | Hunan | All patients with confirmed COVID-19 admitted to the First Hospital of Changsha and Loudi Central Hospital | Cohort | 159 | 49.8 | 46 (34–59)* | No | Two estimates of LOS were provided in this study: one estimate for discharged patients only and one estimate for all patients (including still-hospitalised). The estimate which included still-hospitalised patients was excluded. |
Cheng et al. [66] | 20 March 2020 | Published | 28 January 2020–17 February 2020 | China | Wuhan, Hubei | All COVID-19 patients admitted to Tongji Hospital | Cohort | 113 | 52.4 | 63 (50–71)* | No | Patients still hospitalised at the end of the study. LOS was only reported for deaths. |
Deng et al. [67] | 20 March 2020 | Published | 01 January 2020–21 February 2020 | China | Wuhan, Hubei | Recovered and dead patients admitted two tertiary hospitals in Wuhan (Hankou and Caidian branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, and Hankou branch of Central Hospital of Wuhan) | Cohort | 225 | 55.1 | 21–94*** | Yes | Only enrolled dead and discharged patients within the study, so data is still censored. |
Ding et al. [68] | 26 March 2020 | Published |  | China | Wuhan, Hubei | Patients infected with both influenza and COVID-19 admitted to Tongji Hospital | Cohort | 5 | 40 | 39–66*** | Yes |  |
Du et al. [69] | 03 April 2020 | Published | 09 January 2020–15 February 2020 | China | Wuhan, Hubei | Severe patients with confirmed COVID-19 admitted to Hannan Hospital and Wuhan Union Hospital | Cohort | 85 | 72.9 | 65.8 ± 14.2** | Yes | LOS was only reported for deaths. |
Fan et al. [70] | 05 March 2020 | Published | 20 January 2020–19 February 2020 | China | Shanghai | All confirmed COVID-19 cases in Shanghai Public Health Clinical Center | Cohort | 93 | 49.3 | 50.5 (36–64)* | No | Patients still hospitalised at the end of the study. |
Graselli et al. [32] | 06 April 2020 | Published | 20 February 2020–25 March 2020 | Italy | Lombardy | All patients with laboratory-confirmed COVID-19, referred to Ospedale Maggiore Policlinico, and subsequently admitted to one of the ICUs amongst 72 hospitals in the network | Cohort | 1591 | 82 | 63 (56–70)* | No | Patients still hospitalised at the end of the study. |
Guan et al. [36] | 28 February 2020 | Published | 11 December 2019–31 January 2020 | China | National | Hospitalised lab-confirmed cases of COVID-19 from 552 hospitals in 30 provinces in China | Cohort | 1099 | 58.1 | 47.0 (35.0–58.0)* | No | 1029/1099 patients were still hospitalised. |
ICNARC [28] | 16 April 2020 | Other | 16 April 2020 | UK | National | Patients critically ill with confirmed COVID-19 reported to ICNARC up to 16 April 2020 from critical care units participating in the Case Mix Programme. This is a national audit that is being continually updated. | Cross-sectional | 2936 | 72.1 | 60 (52–68)* | No | Patients still hospitalised at the end of the study. |
ISARIC [27] | 08 April 2020 | Other | 25 March 2020 | Worldwide (25 countries) | Â | Hospitalised patients with confirmed or suspected COVID-19 submitted electronically by participating sites to the ISARIC database. | Cohort | 3316 | 0.5 | 71* | No | Patients still hospitalised at the end of the study. Age and sex are only available for all patients. Majority of data is from the UK (82%). LOS estimates were only provided for discharges and deaths. |
Liu et al. [71] | 13 March 2020 | Pre-print | 16 January 2020–15 February 2020 | China | Wuhan, Hubei | Confirmed cases of COVID-19 medical staff admitted to Union Hospital | Cohort | 64 | 36 | 35 (29–43)* | No | Patients still hospitalised at the end of the study. |
Liu et al. [37] | 12 March 2020 | Published | 22 January 2020–11 February 2020 | China | Hangzhou, Zhejiang | Patients with confirmed COVID-19, admitted to Xixi hospital | Cohort | 10 | 40 | 42 (34–50)* | No | Patients still hospitalised at the end of the study (3 transferred to ICU). |
Liu et al. [72] | 23 February 2020 | Pre-print | 20 January 2020–03 February 2020 | China | Chongqing | Hospitalised patients with confirmed COVID-19 at Chongqing University Three Gorges Hospital | Cohort | 51 | 62.7 | 45 (34–51)* | Yes |  |
Mo et al. [73] | 16 March 2020 | Published | 01 January 2020–05 February 2020 | China | Wuhan, Hubei | All confirmed COVID-19 patients admitted to Zhongnan Hospital | Cohort | 22 | Missing | Missing | No | LOS is reported for both deaths and discharges; however, sample size was only reported for deaths, so the LOS for discharges was excluded. Age and sex of the population were not provided. |
Pan et al. [74] | 13 February 2020 | Published | 12 January 2020–06 February 2020 | China | Wuhan, Hubei | Patients with RT-PCR confirmed COVID-19 infection presenting at Union Hospital, Tongji Medical College. Patients with severe respiratory distress and/or oxygen requirement at any time during the disease course were excluded. | Cohort | 21 | 29 | 40 ± 9** | Yes | Severe cases were excluded from this study. |
Petrilli et al. [35] | 11 April 2020 | Pre-print | 01 March 2020–07 April 2020 | USA | New York, NY | All patients with laboratory-confirmed COVID-19 treated at an academic health system in New York City (NYU Langone Health) | Cross-sectional | 1273 | 50.5 | 52 (36–65)* | No | In the critical illness, some patients still hospitalised at the end of the study. In the non-critical, all patients discharged (no deaths). |
Qi et al. [75] | 03 March 2020 | Pre-print | 19 January 2020–16 February 2020 | China | Chongqing | Laboratory-confirmed COVID-19 patients admitted to 3 designated hospitals (Qianjiang Central Hospital of Chongqing, Chongqing Three Gorges Central Hospital, and Chongqing Public Health Medical Center) in Chongqing provincial municipality | Cohort | 164 | 55.8 | 48 (35–65)* | No | Patients still hospitalised at the end of the study. Not clear whether they have included patients still admitted to hospital or limited to only those that have been dead or discharged within their LOS estimate |
Qui et al. [29] | 25 March 2020 | Published | 17 January 2020–01 March 2020 | China | Wenzhou, Zhejiang | Paediatric patients (aged 0–16 years) with confirmed COVID-19 from electronic medical records in three hospitals in Zhejiang, China (Ningbo Women and Children’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, and Wenzhou Central Hospital of Wenzhou) | Cohort | 36 | 63.9 | 8 ·3 ± 3 ·5** | Yes |  |
Shen et al. [45] | 27 March 2020 | Published | 20 January 2020–25 March 2020 | China | Shenzhen, Guangdong | Laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who were admitted to Shenzhen Third People’s Hospital who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment, PAO2/FIO2 <300, and mechanical ventilation. | Cohort | 5 | 60 | 36–73*** | No | Patients still hospitalised at the end of the study. |
Shi et al. [30] | 10 March 2020 | Published | 19 January 2020–15 February 2020 | China | Shanghai | Children admitted to outpatient and emergency department with confirmed COVID-19 to Children’s Hospital of Fudan University, Shanghai | Cohort | 10 | 50 | 6.0 ± 4.2** | No | Only 4 patients had been discharged when LOS was calculated. |
Shi et al. [44] | 07 April 2020 | Pre-print | 01 February 2020–15 March 2020 | China | Wuhan, Hubei | Patients with COVID-19 (severe clinical classification) treated at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology | Cohort | 42 |  |  | Yes | No critical cases |
Shi et al. [42] | 25 March 2020 | Published | 20 January 2020–15 February 2020 | China | Wuhan, Hubei | Patients with laboratory-confirmed COVID-19 admitted to Renmin Hospital | Cohort | 49 | 53.7 | 64 (21–95)* | No | Only report LOS for those who have died: 77% remained in hospital |
Shi et al. [43] | 24 February 2020 | Published | 20 December 2019–08 February 2020 | China | Wuhan, Hubei | Patients with confirmed COVID-19 admitted to Wuhan Jinyintan Hospital or Union Hospital of Tongji Medical College | Cohort | 29 | Missing | Missing | No | Patients still hospitalised at the end of the study. |
Spiteri et al. [33] | 05 March 2020 | Published | 24 January 2020–21 February 2020 | EU/EEA | EU/EEA | European surveillance data of confirmed COVID-19 patients | Cross-sectional | 17 | Missing | Missing | No | Patients still hospitalised at the end of the study. |
Tang et al. [76] | 26 March 2020 | Published | 24 December 2019–07 February 2020 | China | Wuhan, Hubei | Patients with COVID-19-induced ARDS admitted to the Department of Pulmonary and Critical Care at Wuhan Pulmonary Hospital in Hubei Province of China | Case control | 73 | 61.6 | 67 (57–72)* | No | Not clear whether LOS included patients remaining in hospital, or if they were excluded. |
Tian et al. [77] | 23 March 2020 | Pre-print | Not stated | China | Liaocheng, Shandong | Not stated | Cohort | 37 | 45.9 | 44.3 ± 1.67** | No | Not clear what the study population is; location and hospital have been assumed, and study dates have not been provided. Patients still hospitalised at the end of the study. |
Tian et al. [78] | 07 April 2020 | Pre-print | 21 January 2020–05 March 2020 | China | Jilin | Three designated tertiary hospitals in Jilin province including the First Hospital of Jilin University (n=3), Changchun Infectious Disease Hospital (n=42), and Siping Infectious Disease Hospital (n=14) | Cohort | 59 | 57.6 | 41 (29–52)** | Yes | Dates are different in abstract and main text. |
Wang et al. [39] | 20 March 2020 | Published | 01 January 2020–05 March 2020 | China | Wuhan, Hubei | All confirmed cases of COVID-19 over 60 years old admitted to Renmin Hospital of Wuhan University in Wuhan, China. | Cohort | 339 | 49 | 69 (65–76)* | No | LOS was provided for survivors; however, not all survivors had been discharged (91/274), and so this estimate includes still-hospitalised patients. |
Wang et al. [38] | 10 April 2020 | Pre-print | 16 January 2020–04 March 2020 | China | Sichuan | Laboratory-confirmed cases of COVID-19, which were reported to the Sichuan Center for Disease Control and Prevention (CDC) through the National Notifiable Diseases Reporting System (NNDRS). | Cross-sectional | 538 | 53 | Missing | No | Not clear whether patients still-hospitalised were included in the LOS estimate, we have assumed that still-hospitalised patients were included. |
Wu et al. [55] | 29 February 2020 | Pre-print | 25 December 2019–11 February 2020 | China | Wuhan, Hubei | COVID-19 patients admitted to Wuhan Jinyintan Hospital | Cohort | 188 | 63.3 | 51.9 ± 14.26** | Yes |  |
Wu et al. [79] | 29 February 2020 | Published | 22 January 2020–14 February 2020 | China | Jiangsu | All admitted patients for COVID-19 to First People’s Hospital of Yancheng City, the Second People’s Hospital of Yancheng City, and the Fifth People’s Hospital of Wuxi. | Cohort | 21 | 48.8 | 46.10 ± 15.42** | No | 80 patients but LOS only reported for those discharged. |
Wu et al. [80] | 13 March 2020 | Published | 25 December 2019–13 February 2020 | China | Wuhan, Hubei | Confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital | Cohort | 144 | 63.7 | 51 (43–60)* | No | Unclear whether LOS included those who died. State that some of their cases have previously been described in other studies. Age and sex are regarding total population (including those remaining in hospital). |
Wu et al. [81] | 09 April 2020 | Pre-print | 26 February 2020 | China | Shanghai | Adult COVID-19 patients admitted to Shanghai Public Health Clinical Center. | Cohort | 175 | 47 | 50* (16–85)*** | Yes | Only enrolled discharged and mild patients. No start date for the study provided. |
Xia et al. [31] | 26 February 2020 | Published | 23 January 2020–18 February 2020 | China | Wuhan, Hubei | Paediatric inpatients with COVID-19 infection confirmed by pharyngeal swab in Wuhan Children’s Hospital | Cohort | 18 | 65 | 2* | No | Statistic used for LOS not completely clear. Two neonates remain under observation but had negative CT findings. |
Xiao et al. [82] | 08 April 2020 | Pre-print | 05 January 2020–08 March 2020 | China | Wuhan, Hubei | Hankou Hospital, COVID-19 confirmed patients ≥18 years, entire stay in hospital ≥48 h, not undergone renal replacement therapy (RRT) before admission | Cohort | 287 | 55.7 | 62 (51–70)* | No | Not clear whether LOS estimate includes still-hospitalised patients, or only those who are discharged/dead. |
Xie et al. [83] | 02 April 2020 | Published | 02 February 2020–23 February 2020 | China | Wuhan, Hubei | All laboratory-confirmed COVID-19 discharged patients from the non-ICU ward at Wuhan Jinyintan Hospital | Cohort | 79 | 55.7 | 60 (48–66)* | Yes | Non-ICU LOS reported. Study dates are based on discharge dates, not admission dates. |
Xu et al. [84] | 26 March 2020 | Pre-print | 01 January 2020–20 February 2020 | China | Hubei/Anhui | Patients with confirmed COVID-19 admitted to Union Hospital of Huazhong University of Science and Technology, and COVID-19 patients admitted to the Second People’s Hospital of Fuyang City, in Anhui province. | Cohort | 355 | 54.4 |  | No | Not clear whether patients remain in hospital at the study end. LOS only mentioned amongst those with AKI who died. Sex/age distribution not specified for this subgroup. |
Yan et al. [85] | 30 March 2020 | Pre-print | 31 January 2020–09 March 2020 | China | Hubei | Hospitalised, non-critically ill patients with COVID-19 admitted to No. 3 People’s Hospital of Hubei Province that had the available RNA viral data to estimate the duration of viral shedding. | Cohort | 120 | 45 | 52 (35–63)* | No | Investigating viral shedding so only included patients with RNA viral data. Most patients (99.2%) in the cohort were non-critically ill patients with COVID-19 due to triage strategies. Had 168 patients admitted over the study period, only reported LOS for 120 that had been discharged. |
Yang et al. [54] | 24 February 2020 | Published | 24 December 2019–09 February 2020 | China | Wuhan, Hubei | Critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-Tan Hospital | Cohort | 52 | 67 | 59 ·7 ± 13 ·3** | Yes | LOS only presented for those that have died. |
Yin et al. [40] | 11 April 2020 | Pre-print | 28 January 2020–08 March 2020 | China | Wuhan, Hubei | Female inpatients (20–40 years old, female) from January 28 to February 28, 2020, at Wuhan Union and Tongji hospitals of Huazhong University of Science and Technology | Cohort | 66 | 0 | 20–40 | No | Only include pregnant women. Not clear whether patients still-hospitalised were included in the LOS estimate, we have assumed that still-hospitalised patients were included. |
Yuan et al. [86] | 29 March 2020 | Published | 11 January 2020–13 February 2020 | China | Shenzhen, Guangdong | Confirmed COVID-19 patients which were admitted and subsequently discharged from Shenzhen Third People’s Hospital. | Cohort | 94 | 44.7 | 40 (1–78)* | Yes | Study dates in abstract and main text differ (abstract: 5 January to 13 February; main text: 11 January to 4 February with follow-up to 13 February) |
Zeng et al. [87] | 11 April 2020 | Pre-print | 05 January 2020–08 March 2020 | China | Wuhan, Hubei | Hankou Hospital, patients ≥18 years, entire stay in hospital ≥48 h. Confirmed cases of COVID-19 | Cohort | 274 | 55 | 60 ± 15** | No | Excluding short hospital stays (<less 48 h). Not clear whether LOS estimate includes still-hospitalised patients, or only those who are discharges/dead. |
Zhang et al. [88] | 06 March 2020 | Pre-print | 02 January 2020–15 February 2020 | China | Wuhan, Hubei | Confirmed COVID-19 patients admitted to Zhongnan Hospital of Wuhan University | Cohort | 32 | 48.9 | 55 (39–66.5)* | No | Patients still hospitalised at the end of the study. |
Zhang et al. [41] | 26 March 2020 | Pre-print |  | China | Shaanxi | Confirmed COVID-19 patients admitted to Xi’an No. 8 Hospital (Shaanxi Provincial Infectious Disease Hospital) and the First Affiliated Hospital of Xi’an Jiaotong University | Cohort | 25 |  |  | No | Does not describe patient characteristics and statistic for non-ICU LOS not specified |
Zhao et al. [89] | 30 March 2020 | Pre-print | 21 January 2020–29 February 2020 | China | Beijing | Laboratory-confirmed COVID-19 in Beijing YouAn Hospital, Beijing | Cohort | 77 | 44.2 | 52 ± 20** | No | Patients still hospitalised at the end of the study. |
Zhou et al. [58] | 11 March 2020 | Published | 29 December 2019–31 January 2020 | China | Wuhan, Hubei | All adult (≥18 years) inpatients who were hospitalised for COVID-19 (diagnosed with COVID-19 according to WHO interim guidance) and had a definite outcome (dead or discharged), at Jinyintan Hospital and Wuhan Pulmonary Hospital | Cohort | 191 | 62 | 56 (46–67)* | Yes | The study dates are based on discharge dates and not admission dates. Before 11 January 2020, SARS-CoV-2 RNA detection results were not available in the electronic medical records, from which data for this study were obtained retrospectively; therefore, this study includes 29 of the 41 patients originally reported on. |