Table 2.

Studies with LOS as an Outcome

Reference	Data source and location	Number of patients	Study population	Definition of care fragmentation	Ottawa bias assessment	Findings
Galanter 201314	Chicago	228,151	Patients admitted to 5 teaching hospitals 2007–2008	Admitted to more than one hospital	Fair	Patients admitted to more than one hospital mean LOS 5.58 ± 8.42 Patients with multiple admissions to one hospital mean LOS 5.77 ± 8.42
Brooke 201518	USA (Medicare)	1,111,046	Patients undergoing one of 12 major operations* readmitted within 30 days, 2001–2011	Readmission to a different hospital than the one where the surgery was performed	Good	Fragmented vs. not (mean LOS) Vascular: 6.7 vs. 8.2 Cardiothoracic: 5.6 vs. 7.1 General: 6.5 vs. 7.1 Neurosurgery: 6.4 v. 7.4 Orthopedic: NR
Flaks-Manov 201634	Israel	27,057	Adult patients with state insurance with at least 1 readmission in 2010	Readmission to a different hospital (DHR) with or without a health information exchange (HIE)	Good	DHR without HIE: HR 0.90 (CI 0.86–0.94) DHR with HIE: 0.85 (0.79–0.91)
McAlister 201712	Canada	39,368	Patients with heart failure, 2004–2013 readmitted within 30 days	Readmission to a different hospital than the patient was discharged from	Good	Fragmented mean LOS 11.6 (11.3–12.0) n = 6597 Non-fragmented mean LOS 11.0 (10.1–12.0) n = 32771
Graboyes 201715	California	561	Patients readmitted within 30 days of a head and neck cancer surgery, 2008–2010	Readmission to a hospital other than where surgery was performed	Good	Median LOS fragmented v. not 4 vs. 5
Burke 201811	USA (NRD)	2,722,821	Patients readmitted within 30 days in 2013	Readmission to a different hospital than the patient was discharged from	Good	Readmission to non-index adjusted HR 0.87 (0.86–0.88)

*Open AAA repair, infra-inguinal arterial bypass, aorto-bifemoral bypass, coronary artery bypass surgery, esophagectomy, colectomy, pancreatectomy, cholecystectomy, ventral hernia repair, craniotomy, hip or knee replacement