{
  "abstract": "We want to commend the authors on their novel use of healthcare informatics to identify factors associated with increased length of stay (LOS), given the emphasis on this as a quality metric and a benchmark for hospital administrators.1 The authors’ findings that non-modifiable factors—including body mass index, age, frailty, and Injury Severity Score—are associated with increased LOS are in line with prior literature.1–5 Additionally, non-clinical factors like discharge destination and government insurance significantly impact LOS.1 2 These factors are often non-modifiable and skew LOS indices. In our opinion, the influence of these non-clinical factors underscores why LOS is a poor and fundamentally weak outcome metric for measuring the quality of care and efficacy of surgical stabilization of rib fractures (SSRF). The benefits of timely SSRF are better captured through objective outcome measures such as reduced duration of mechanical ventilation, fewer unplanned intubations, decreased narcotic utilization, and less time spent in the intensive care unit.4 6",
  "authors": [
    {
      "affiliations": [
        "Surgery, Trinity Health of New England, Hartford, Connecticut, USA"
      ],
      "name": "Mary Noory"
    },
    {
      "affiliations": [
        "Surgery, Trinity Health of New England, Hartford, Connecticut, USA"
      ],
      "name": "Sarah Posillico"
    },
    {
      "affiliations": [
        "Surgery, Trinity Health of New England, Hartford, Connecticut, USA"
      ],
      "name": "Andrew R Doben"
    }
  ],
  "title": "Length of stay: the outcome metric that has long overstayed its value",
  "uid": "4594b66a-b4f3-5a38-bef4-6d659536f39f"
}