Review Article

Length of Hospital Stay and its Related Factors in Iran: A Systematic Review and Meta-Analysis

A meta-analysis


Background: One of the effective indicators used to determine the efficiency and optimal use of hospital resources is the length of stay (LOS). Then, we aimed to determine LOS and its related factors in Iran.

Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, PubMed, SID, MagIran, and Medlib from 1995 to 2022 using a combination of medical subject. STATA version 11 used for data analysis.

Results: Overall, 75 (cross-sectional, cohort, and case-control) reports were identified. The average length of stay in Iranian hospitals was 6.7 (95% CI: 5.32 -7.74) d. There was a significant relationship between the length of stay in the hospital and different wards of hospital (P=0.001). The average of men’ LOS was longer than women were [6.9 (95% CI: 5.32 -7.74) vs. 3.9 (95% CI: 1.67-9.41)]. Moreover, the average LOS before and after the Health Transformation Plan (HTP) in Iran has changed, so that it has increased from 5.8 (95% CI: 4.39 -7.86) to 7.1 (95% CI: 5.59 -9.25) d after HTP (P=0.30).

Conclusion: The average length of stay of patients in Iranian hospitals is more than the expected index of the Ministry of Health and Medical Education and is in the unfavorable range (> four days). Moreover, considering the direct effect of the type of departments on LOS; therefore, hospital managers should pay more attention to hospital processes using new process-oriented and customer-oriented management approaches.


1. Qodoosinejad J, Daemi A, Saadati M, Yaghoubi R (2017). Evaluation of the efficiency of Tabriz hospitals; using the Pabon lasso model in a 5-year period. EBHPME,1(3):151-7.
2. Liu Y, Phillips M, Codde J (2001). Factors influencing patients' length of stay. Aust Health Rev, 24(2):63-70.
3. Hosseini-Shokouh SM, Sadeghian K, Ameryoun A, Zaboli R (2019). Organizational factors affecting a patient’s average length of stay in hospital: Systematic review. J Mil Med, 20(6):577-88.
4. Zanganeh Baygi M, Khammarnia M, Barfar E, Setoodehzadeh F, Shah Husseini M (2019). Investigation of informal healthcare payments after health transformation plan: A case study in the southeast of Iran. EBHPME, 3(2):112-20.
5. Chavehpour Y, Rashidian A, Woldemichael A, Takian A (2019). Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran. BMC Health Serv Res, 19(1):1-8.
6. Zhang J, Harvey C, Andrew C (2011). Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Aust N Z J Psychiatry, 45(7):578-85.
7. Miri Bonjar M, Khammarnia M, Bakhshi M, Ansari-Moghaddam A, Okati–Aliabad H, Mohammadi M (2019). Impact of the health transformation plan on the number of surgical operations and their cancelation. Inquiry, 56: 0046958019846385 .
8. Lim A, Tongkumchum P (2009). Methods for analyzing hospital length of stay with application to inpatients dying in Southern Thailand. Glob J Health Sci, 1(1):27.
9. Hachesu PR, Ahmadi M, Alizadeh S, Sadoughi F (2013). Use of data mining techniques to determine and predict length of stay of cardiac patients. Healthc Inform Res, 19(2):121-9.
10. Moloney E, Bennett K, Silke B (2004). Length of hospital stay, diagnoses and pattern of investigation following emergency admission to an Irish teaching hospital. Ir Med J, 97(6):170-2.
11. Khammarnia M, Ansari-Moghaddam A, Barfar E, et al (2021). Systematic review and meta-analysis of hospital acquired infections rate in a middle east country (1995-2020). Med J Islam Repub Iran, 35:102.
12. Formiga F, Chivite D, Manito N, Mestre AR, Llopis F, Pujol R (2008). Admission characteristics predicting longer length of stay among elderly patients hospitalized for decompensated heart failure. Eur J Intern Med,19(3):198-202.
13. Ulanja MB, Beutler BD, Antwi-Amoabeng D, et al (2022). Factors Affecting Inpatient Mortality and Length of Stay in Nonmetastatic Colorectal Cancer: Insights from the National Inpatient Sample. Am J Clin Oncol, 45(1):14-21.
14. Zamane F, Yazdani Charati J, Fayyaz Movaghar A, Shabankhani B (2020). Factors Affecting Hospital Length of Stay Using Mixed Poisson Regression Models. J Maz Univ Med, 30(191):66-80.
15. Shaban M, Salsali M, Kamali P, Poormirzakalhori R (2002). Assessment the effects of respiratory exercise education in acute respiratory complication and the length of patient hospitalization, for undergoing coronary artery by-pass surgery in Kermanshah Emam Ali hospital. Hayat, 8(2):12-2.
16. Rafiee M, Ayatollahi S (2002). Modeling the length of stay of patients in Valiasr (AS) and social security hospitals in Arak based on some demographic factors. Arak Med Univ, 5(4): 28-35.
17. Askarian M, Gooran NR (2003). National nosocomial infection surveillance system–based study in Iran: additional hospital stay attributable to nosocomial infections. Am J Infect Control, 31(8):465-8.
18. Falah R, Falakolaflaki B, Tadayon P, Mohammadian F (2003). The relationship between the time of onset of fluid regime and the duration of hospitalization and the time of return of movements. J Adv Med Biom Res, 11(44):19-25.
19. Zokaee A, Moosavi K (2005). Evaluation Of Factors Influencing Icd Stay Time After Coronary Artery Bypass. An Military Health Sci Res, 3(2): 553-558.
20. Rajaeefard A, Rafiee M (2006). Modeling of Hospital length of stay based on mixed Poisson distribution. J Babol Univ Med Sci, 8:36-43.
21. Khorshidi H, Azimian M, Fazlian M (2007). The Bupivacaine effects on opioids usage and admission duration in patients underwent inguinal hernia repair. Armaghane Danesh, 12(1):11-8.
22. Teimuri H, Sabzi F (2006). Comparing the consequences of operation and hospitalization courses on men and women after coronary bypasses. J Ilam Univ Med Sci, 14(1): 24-32.
23. Rafiee M, Ayatollahi S, Behboodian J (2006). Comparison of different strategies for modeling the length of stay of patients admitted to teaching hospitals in Shiraz. Med J Tabriz Uni Med Sciences, 29(2): 43-51.
24. Tavalaei A, Assari SH‎, Habibi M, Khoddami H R, Radfar SH, Naderi M‎, Kachoei H (2007) . Length of Stay at Psychiatry Ward in Baqyiatallah(a.s.) Hospital. J Mil Med, 9(1):43-50.
25. Rafiei M, Ayatollahi S, Behboodian J (2007). Length of hospital stay at Arak (central Iran) maternity clinics using proposed zero-inflated negative binomial modeling. Pak J Biol Sci, 10(15):2510-6.
26. Rezamand A, Pedram M , Zandian KH (2007). Evaluation of the effect of GCSF on the reduction of neutropenia, fever and length of hospital stay in chemotherapy-treated children due to lymphoblastic leukemia. Jundishapur J Health Med Sci, 6(3): 304-308.
27. Rafiei M, Ayatollahi MT (2006). Stay of patients admitted to intensive of mortality rate and length of stay of patients admitted into the intensive care unit of Arak Vali-Asr Hospital. Arak Med Univ, 2(3): 55-62.
28. Mardani M, Mohsenzadeh A, Ardakani D, Birjandi G (2009). The relationship between nutritional status of children under two years of age with gastroenteritis and their length of hospital stay. Lorestan J Health Med Sci, 10(2):21-30.
29. Karami K, Rostamighadirian F (2009). The effect of educational-supportive interventions on stress of mothers with premature infants and length of hospital stay. Lorestan J Health Med Sci, 11(2):67-73.
30. Haji NE, Safamanesh S, Khoushkar A, Hajinasrelah G, Peyvandi H (2010). The Relation of Drain Insertion and Post Hospital Staying in Uncomplicated Laparoscopic Cholecystectomy. Ir J Surg, 18(1): 57-61.
31. Arab M, Zareei A, Rahimi A, Rezaeian F, Akbari FE (2010). Analysis of factors affecting length of stay in public hospitals in Lorestan Province, Iran. Hakim Res J, 12(4):27-32.
32. Ravangard R, Arab M, Zeraati H, Rashidian A, Akbarisari A, Mostaan F (2011). Patients' length of stay in women hospital and its associated clinical and non-clinical factors, Tehran, Iran. Ir Red Crescent Med J, 13(5):309-15.
33. Izadi-Mood N, Tavahen N, Masoumi GR, et al (2011). Demographic Factors, Duration of Hospitalization, Costs of Hospitalization, and Cause of Death in Patients Intoxicated with Amphetamines and Opioids. J Isfahan Med Sch, 29(146): 890-900.
34. Mood NE, Sabzghabaee AM, Safdari A, Yaraghi A (2011). Clinical Signs, Hospitalization Duration and Outcome of Tramadol Intoxication. J Isfahan Med Sch, 28(117): 1187-1193.
35. Zeighami Mohammadi S, Haghighi SA (2011). Relationship between serum creatinine level and mortality and length of hospital stay in patients with heart failure. J Nur Mid, 9(3): 164-173.
36. Haghgoshaei E, Narimani M, Shahla A, Takbiri A, Gorji H (2011). Day clinic: a model for reducing the length of stay in hospitals. J Health Adm, 14(46): 21-30.
37. Zolfaghari M, Arbabi M, Pedram Razi SH, Bayat KH, Bavi A (2012). Effectiveness of a multifactor educational intervention on delirium incidence and length of stay in patients with cardiac surgery. Hayat, 18(1): 67-78.
38. Bahrami N, Soleymani MA, Sharifnia H, Shayegan H, Masoudi R, Ranjbar H (2011). Predicting the length of hospitalization and the percentage of deaths of patients in the intensive care unit. Urmia Med J, 23(5): 466-470.
39. Asgharzadeh Haghighi S, Zeighami Mohammadi S (2012). Mortality and length of hospital stay in elderly with systolic heart failure at Alborz Hospital in Karaj (2003-2008). J Inflammatory Dis, 15(4):86-94.
40. Abdi AH, ZeighamiMohammadi S, Hoseini M, Babagholzadeh S, Farmani P (2018). Mortality and Length of Hospital Stay in Elderly with Hospital–Acquired Pressure Ulcer in Alborz Hospital of Karaj. Alborz Univ Med J, 7(1):15-23.
41. Rezvan Z, Alizadeh A (2013). Effectiveness of day center of Occupational Therapy on Self–Esteem and the Length of Hospitalization in patients with chronic mental patients. J Res Rehabilitation Sci, 9(4): 658-667.
42. Behnam Vashani H, Abolfazli M, Boskabadi H (2013). The effect of non-nutritive sucking on weight gain and length of stay in preterm infants. Evid Based Care, 3(3):43-50.
43. Mahmoodi S, Zareei A (2013). Evaluation of the effect of sensory-motor intervention around the mouth in premature infants on reducing hospital stay. J Alborz Univ Med Sci, 2(3):6-16.
44. Alizadeh Taheri P, Goodarzi Z, Shariat M, Nariman SH, Nick Zinat E (2013). The effect of sunflower oil massage on the duration of hospitalization in premature infants admitted to selected hospitals of Tehran University of Medical Sciences in 2012. J Alborz Univ Med Sci, 2(2):59-66.
45. Boushehri E, Khamseh ME, Farshchi A, Aghili R, Malek M, Ebrahim Valojerdi A (2013). Effects of morning report case presentation on length of stay and hospitalisation costs. Med Educ, 47(7):711-6.
46. Moosazadeh M, Yegane M, Aghaei I, Mahmoodi S, Mehrzad F, Amiresmaili M (2014). Medical adverse events during patient’s hospitalization at training Hospitals in Kerman. J Holistic Nur Mid, 24(2):68-76.
47. Haghparast-Bidgoli H, Saadat S, Bogg L, Yarmohammadian MH, Hasselberg M (2013). Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran. BMC Health Ser Res, 13(1):1-11.
48. Akbarzadeh M, Shabiri F, Mahjoob H, Ebrahimi R (2014). Evaluation of factors affecting the duration of hospitalization from the beginning of labor to discharge using Cox regression model. Ir J Obs Gyn Inf, 17(105): 1-9.
49. Valizadeh S, Hosseini MB, Karimijavan G, Amirteimori I (2014). Effect of oral massage vs. non-nutritive sucking on attainment of independent oral feeding and duration of hospitalization in NICU: a randomized trial. Hayat, 20(1):38-47.
50. Jafari M, Bayatmokhtari M, Kermansaravi F (2014). The effect of kangaroo mother care on weight gain, stay lengthh and controlling temperature of preterm neonates with low birth weight in neonatal intensive care units of selected hospitals in Mashhad. Med Surg Nur J, 3(1): 32-37.
51. Poorreza A, Salavati S, Sadeghi DS, et al (2015). Factors influencing the length of stay in infectious ward of Razi hospital in Ahvaz: Iran. Health Inform Manage, 11(6): 779-788.
52. Bijani B, Mozhdehipanah H, Jahanihashemi H, Azizi S (2014). The impact of pneumonia on hospital stay among patients hospitalized for acute stroke. Neurosciences (Riyadh) , 19(2):118-23.
53. Hashemifard Adeleh, Ehsan SS, Ribah (2020). Analysis of hospitalization duration of stroke patients in Sabzevar Vasei Hospital in 2012 using numerical regression models. Med Sch, 21(6):17-24.
54. Mousavi SAJ, Fereshtehnejad S-M, Khalili N, Naghavi M, Yahyazadeh H (2014). Arterial blood gas and spirometry parameters affect the length of stay in hospitalized asthmatic patients. Med J Islam Repub Iran, 28:4.
55. Vahidi R, Kushavar H, Khodayari R (2006). Factors affecting coronary artery patients hospital length of stay of Tabriz Madani hospital 2005-2006. J Health Admin, 9(25):63-8.
56. Iranmanesh S, Shamsi A, pour Aboli B, Movahedi Z (2015). The effect of breast milk odor on transition time from gavage to oral feeding and hospital stay in premature infants. Infant Child Adolesc Nutr, 7(1):5-11.
57. Shahriari M, Golshan A, Alimohammadi N, Abbasi S, Fazel K (2015). Effects of pain management program on the length of stay of patients with decreased level of consciousness: A clinical trial. Iran J Nurs Midwifery Res, 20(4):502-507.
58. Karim H, Etminani K, Tara M, Mardani M (2015). Identifying factors associated with length of hospital stay using decision tree. J Health Admin, 18(61):57-68.
59. Karim H, Tara M, Etminani K (2015). Factors associated with length of stay based on admission data in Emam-Reza and Ghaem Hospitals of Mashhad. Health Inform Manage, 12(4): 405-415.
60. Kermani B, Gharsi M, Ghanbari B, et al (2015). The relationship between the levels of patient care and length of stay in hospital. Neu J, 3(3):32-40.
61. Sedaghat Siyahkal M (2016). Assessing the length of stay and influential factors among general Intensive Care Units in hospitals affiliated to Tehran University of Medical Sciences. J Hos, 14(4):51-57.
62. Salehi Z, Nouri JM, Khademolhoseyni SM, Ebadi A (2015). The effect of education and implementation of evidence-based nursing guidelines on infants’ weight gaining in NICU. Glob J Health Sci, 7(2):148-153.
63. Babamohamadi H, Tangestani F, Soleimani M, Abbasi Dorche S (2017). Effect of a sedation guideline on the duration of mechanical ventilation and length of stay in intensive care unit. Koomesh, 19(2): 380-390.
64. Torabipour A, Arab M, Zeraati H, Rashidian A, Sari AA, Sarzaiem MR (2016). Multivariate analysis of factors influencing length of hospital stay after coronary artery bypass surgery in Tehran, Iran. Acta Med Iran, 54(2): 124-133.
65. Sari AA, Rezaei S, Arab M, Majdzadeh R, Matin BK, Zandian H (2016). Effects of smoking on cost of hospitalization and length of stay among patients with lung cancer in Iran: a hospital-based study. Asian Pac J Cancer Prev, 17(9): 4421-4426.
66. Yazdannik A, Zarei H, Massoumi G (2016). Comparing the effects of adaptive support ventilation and synchronized intermittent mandatory ventilation on intubation duration and hospital stay after coronary artery bypass graft surgery. Iran J Nurs Midwifery Res, 21(2):207-212.
67. Arefnezhad M, Purmand S, Rava M, Isfahani P (2017). Survey of the affective factors on the length of hospital stay of acute coronary syndrome patients in Amir-al-momenin Hospital of Zabol in 2014. Com Health J, 10(1):1-10.
68. Vejdani M, Salehabadi R, Saffari SE, et al (2016). Assesment the factors affecting on length of hospitalization stay for elderly of Vaseie hospital in Sabzevar (2014) using count regression models. J Sabzevar Univ of Med Sci, 22(6):1105-1117.
69. Jeddian A, Afzali A, Jafari N (2017). Evaluation of appropriateness admission and hospital stay at educational hospital. Arch Iran Med, 20(1): 16-21.
70. Ghorbani M, Ghaem H, Rezaianzadeh A, Shayan Z, Zand F, Nikandish R (2017). A study on the efficacy of APACHE-IV for predicting mortality and length of stay in an intensive care unit in Iran. F1000 Res, 6: 2032.
71. Roham M, Fatemi MJ, Niazi M, Momeni M (2017). Measuring the amount of serum albumin in burn patients and the relationship between the burned area and length of hospital stay. Tehran Univ Med J Public, 75(5): 387-392.
72. Pourrahimi A, Norozi K, Mohammadi F, Rezasoltani P (2017). Comparison of Costs and Length of Stay of Elderly and Middle-Aged Patients Hospitalized in Tehran's Milad Hospital during Year 2012. Iran J Reh Res, 3(3):11-5.
73. Boskabadi H, Zakerihamidi M (2018). The effect of maternal hospitalization duration on neonatal bilirubin level. Tehran Univ Med J Public, 75(10):715-721.
74. Moradi S, Arshdi-Bostanabad M, Seyedrasooli A, Tapak L, Valizadeh S (2018). The effect of empowerment program on maternal discharge preparation and neonatal length of hospital stay: A randomized controlled trial. Iran J Nurs Midwifery Res, 23(3):172-177.
75. Farahani E, Nourian M, Ahmadi F, Kazemian M (2018). Comparing the effects of cycled and constant lighting on weight gain and length of stay in neonatal intensive care unit among premature neonates: A two-Group randomized controlled clinical trial. Nur Mid Stu, 7(3):93-99.
76. Alaee Karahroudy F (2019). Effects of Parental Empowerment Program on Length of Stay and Readmission Rate of Premature Infant. J Ped Nur, 5(2):22-28.
77. Baniasadi T, Kahnouji K (2019). Factors Affecting length of Stay in Specialized Women Hospital in Bandar Abbas. J Mod Med Inform Sci, 5(1):66-72.
78. Baniasadi T, Kahnouji K, Davaridolatabadi N, Hosseini Teshnizi S (2019). Factors affecting length of stay in Children Hospital in Southern Iran. BMC Health Serv Res, 19(1):949.
79. Sadeghipour F, Geraei M, Kavosi Z, Abedini E (2019). Study of the Duration and Causes of Prolonged Stay of Patients after Doctor's Discharge Order in Shahid Faghihi Hospital. Sadra Med J, 7(2):161-72.
80. Noohi S, Kalantari S, Hasanvandi S, Elikaei M (2020). Determinants of length of stay in a psychiatric ward: A retrospective chart review. Psychiatr Q, 91(2):273-287.
81. Zarrizi M, Paryad E, Khanghah AG, Leili EK, Faghani H (2021). Predictors of length of stay in intensive care unit after coronary artery bypass grafting: development a risk scoring system. Braz J Cardiovasc Surg, 36(1):57-63.
82. Setareh M, Alavi NM, Atoof F (2021). Severity of illness affecting the length of stay and outcomes in patients admitted to intensive care units, Iran, 2019. J Educ Health Promot, 10:142.
83. Orooji A, Nazar E, Sadeghi M, Moradi A, Jafari Z, Esmaily H (2021). Factors associated with length of stay in hospital among the elderly patients using count regression models. Med J Islam Repub Iran, 35:5.
84. Dang Q, Leijdesdorff HA, Hoogendoorn JM, Emmink BL (2022). Factors Affecting Hospital Length of Stay in Geriatric Patients With a Surgically Treated Fragility Ankle Fracture. J Foot Ankle Surg, 61(3):490-496
85. Kirubarajan A, Shin S, Fralick M, et al (2021). Morning discharges and patient length of stay in inpatient general internal medicine. J Hosp Med, 16(6):333-338.
86. Khanna AK, Saager L, Bergese SD, et al (2021). Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor. BMC Anesthesiol, 21:88.
87. Moradi Gh, Piroozi B, Safari H, Esmail nasab N, Mohammadi A, Yari A (2017). Assessment of the Efficiency of Hospitals before and after the Implementation of Health Sector Evolution Plan in Iran Based on Pabon Lasso Model. Iran J Public Health, 46(3): 389-395.
88. Khammarnia M, Ali Nejad A, Bakhshi M (2019). Comparison of Performance Indicators of Zahedan Public Hospitals Before and After Implementation of Hospital Accreditation Plan. Sci J Sch Public Health Inst Public Health Res, 16(2): 145-156.
IssueVol 52 No 9 (2023) QRcode
SectionReview Article(s)
Length of stay Length of hospital stay EMRO region country Iran

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Khammarnia M, BagherBarahoue F, Ansarimoghadam A. Length of Hospital Stay and its Related Factors in Iran: A Systematic Review and Meta-Analysis. Iran J Public Health. 2023;52(9):1877-1888.