Chest
Volume 121, Issue 5, May 2002, Pages 1548-1554
Journal home page for Chest

Clinical Investigations
Musculoskeletal
Impact of Respiratory Complications on Length of Stay and Hospital Costs in Acute Cervical Spine Injury

https://doi.org/10.1378/chest.121.5.1548Get rights and content

Context

Respiratory complications are frequent in patients with acute cervical spinal injury (CSI); however, the importance of respiratory complications experienced during the initial hospitalization following injury is unknown.

Objective

To determine if respiratory complications experienced during the initial acute-care hospitalization in patients with acute traumatic cervical spinal injury (CSI) are more important determinants of the length of stay (LOS) and total hospital costs than level of injury.

Design

A retrospective analysis of an inception cohort for the 5-year period from 1993 to 1997.

Setting

The Midwest Regional Spinal Cord Injury Care System, a model system for CSI, at Northwestern Memorial Hospital, a tertiary referral academic medical center.

Patients

Four hundred thirteen patients admitted with acute CSI and discharged alive. Patients with concurrent thoracic injuries were excluded.

Main outcome measures

Initial acute-care LOS and hospital costs.

Results

Both mean LOS and hospital costs increased monotonically with the number of respiratory complications experienced (p < 0.001, between none and one complication, and between one and two complications; p = 0.24 between two and three or more complications). A hierarchical regression analysis showed that four variables—use of mechanical ventilation, occurrence of pneumonia, need for surgery, and use of tracheostomy—explain nearly 60% of the variance in both LOS and hospital costs. Each of these variables, when considered independently, is a better predictor of hospital costs than level of injury.

Conclusions

The number of respiratory complications experienced during the initial acute-care hospitalization for CSI is a more important determinant of LOS and hospital costs than level of injury.

Section snippets

Subjects

We retrospectively reviewed the database of the Midwest Regional Spinal Cord Injury Care System (MRSCICS) at Northwestern Memorial Hospital (NMH) for all patients with acute CSI admitted from 1993 through 1997. Since trauma to the chest can result in respiratory complications independent of the level of injury, patients with concurrent thoracic injuries were excluded.

Subjects with either motor or sensory neurologic deficits were classified at the highest level of bilateral normal function

Distribution of Neurologic Injury

The distribution of ASIA classification level as a function of neurologic level of injury is presented in Figure 1. Among those with a motor level of injury, complete injuries (ASIA impairment classification A) were present in 79 subjects (44%) and incomplete injuries (ASIA classifications B, C, and D) were found in 92 subjects (51%).13 The ASIA classification was unknown in nine subjects (5%). The distribution of motor levels of injury and ASIA classifications for this cohort did not differ

Discussion

This study demonstrates that the occurrence of respiratory complications in patients with acute CSI contributes significantly to both LOS and hospital costs for the initial acute-care hospital admission. Our analysis shows that four variables—use of mechanical ventilation, occurrence of pneumonia, the need for surgery, and use of tracheostomy—explain nearly 60% of the variance in hospital costs for this cohort. Further, each of these variables, when considered independently, is a better

ACKNOWLEDGMENT

The authors thank David Kamp, MD, and Jacob I. Sznajder, MD for their review of this article.

References (19)

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This project was partially funded by the Department of Education, National Institute on Disability and Rehabilitation Research, No. H133N50002.

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