Authors: Remi A. Kessler; Raj Shrivastava, MD; Sabrina Chen, BA; Deborah Benzil, MD (New York, NY)
Spinal cord injury (SCI) is a devastating disturbance to motor, autonomic and sensory function, with impact on quality-of-life and functional-status. In the US, there are ~17,000 cases of SCI annually. Over one-third of patients will be rehospitalized annually following injury, with a 22-day mean length-of-stay and costs ~$769,000-1,060,000. Healthcare costs in the post-acute phase is dependent on injury severity and age at injury. The goal of this study is to analyze the causes of SCI rehospitalization in the first-year post injury and to use this analysis to design interventions to reduce expenditures across the care continuum.
This study uses a retrospective cohort design including all patients sustaining SCI between 1972-2017. SCI was defined as an acute traumatic lesion of spinal canal neural elements resulting in sensory and/or motor deficit. Exclusion criteria consisted of in-hospital mortality from acute injury or within the first six months post-injury. Data was drawn from National SCI Statistical Center, which is a US prospective longitudinal multi-center study capturing SCI patients' healthcare data. It is the largest SCI database worldwide.
A total of 32,720 patients met inclusion criteria. The male-female breakdown was 80.6% (N=26,365) versus 19.4% (N=6,355). The average age at injury was 35. Vehicular causes and falls were the leading causes of injury (42.2%, 22.4%). Survival at 1-year was 95.4% and 10-years was 82.40%. Analysis of 30-day readmission in 2,904 patients with complete data revealed that genitourinary system diseases were the leading cause of rehospitalization (47.3%), followed by skin pathology (18.7%). Other causes included respiratory, digestive, circulatory and musculoskeletal diseases.
This study suggests that relatively simple interventions to prevent serious urinary-tract-infections and integumentary disruption could dramatically reduce rehospitalization and costs for SCI patients. Further detailed analysis of this large database will likely yield additional critical information to design better post-hospitalization care.