Determinants of Prolonged Hospital Stay and In-Hospital Outcomes among Tuberculosis Patients in Sri Lanka

Background: Tuberculosis (TB) remains a major public health challenge in low- and middle-income countries. Although most patients are managed on an outpatient basis, some require hospitalisation due to disease severity, comorbidities, adverse drug reactions, or social factors limiting safe outpatient care. Understanding factors associated with prolonged hospital stay and adverse in-hospital outcomes is important for optimising patient management and healthcare resource utilisation.Methods: A descriptive cross-sectional study was conducted among adult patients with tuberculosis admitted to the National Hospital for Respiratory Diseases in Sri Lanka from January to February 2026. Data were collected using interviewer-administered questionnaires and clinical records. Patients with pulmonary and extrapulmonary tuberculosis were included. Length of hospital stay was categorised, and prolonged hospitalisation was defined as a stay exceeding 14 days. Adverse outcomes were defined as death, leaving against medical advice (LAMA), or absconding during admission. Associations were assessed using Chi-square or Fisher’s exact tests.Results: A total of 141 patients were included (mean age 56.0 ± 14.9 years; 76.6% male). Pulmonary tuberculosis accounted for 123 (87.2%) cases, while others had extrapulmonary tuberculosis. Most patients were newly diagnosed cases (80.1%). Diabetes mellitus was present in 29.8% of patients, and 66.0% had a history of smoking. Prolonged hospitalisation (>14 days) occurred in 41.1% of patients. Adverse outcomes were observed in 13.5% of patients. Among the nine deaths recorded, respiratory failure was the leading cause of death, followed by myocardial infarction, sepsis/septic shock, and disseminated tuberculosis. No statistically significant associations were identified between socio-demographic, clinical, or behavioural factors and prolonged hospital stay or adverse outcomes.Conclusion: Hospitalised tuberculosis patients commonly had multiple comorbidities, behavioural risk factors, and social vulnerabilities. Prolonged hospitalisation was frequent, likely reflecting disease severity and healthcare system factors rather than individual socio-demographic characteristics alone. Strengthening integrated inpatient and outpatient TB care pathways may help optimise patient outcomes and reduce prolonged hospital stays.