COMPLICATIONS AND COSTS OF MANAGEMENT OF ACUTE SPINAL-CORD INJURY

This study examined the complications and costs of management of patie nts with acute spinal cord injury (ASCI) in a regional, multidisciplin ary acute spinal cord injury unit (ASCIU). Data were available to comp ute length of stay (LOS) on 191 of the first 220 consecutive patients managed in this unit from 1974 to 1981. Specific formulae for assessin g hospital and medical costs were developed based on a systems analysi s approach. The statistical analysis included multiple regression anal ysis for determining the effect of the principal admission characteris tics of ASCI patients, the main types of complications, and the method s of management. The effects of these variables on LOS, costs per day (CPD), and costs per stay (CPS) were determined. Age at admission, sex , and cause of accident had no effect on costs. As expected, increasin g severity of injury to the spinal cord and to the vertebral column ca used a significant increase in the mean LOS and CPS, and increasing to tal trauma load resulted in a significant increase in LOS and CPS. The LOS was shorter for patients admitted sooner after trauma. Respirator y, gastrointestinal, thromboembolic and genitourinary complications an d decubitus ulceration were all associated with marked increases in LO S and CPS. The annual mean CPS decreased dramatically during the perio d of the study from 1974-81 due mainly to a decrease in LOS. Multiple regression analysis showed that severity and level of the spinal colum n and spinal cord injury, and the presence of complications had the mo st significant effects on duration and cost of care. The study also su ggests that a specialized, multidisciplinary regional unit for ASCI pa tients is associated with a reduction in LOS and cost of care.