Complications and costs of management of acute spinal cord injury.

This study examined the complications and costs of management of patients with acute spinal cord injury (ASCI) in a regional, multidisciplinary acute spinal cord injury unit (ASCIU). Data were available to compute length of stay (LOS) on 191 of the first 220 consecutive patients managed in this unit from 1974 to 1981. Specific formulae for assessing hospital and medical costs were developed based on a systems analysis approach. The statistical analysis included multiple regression analysis for determining the effect of the principal admission characteristics of ASCI patients, the main types of complications, and the methods 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, increasing severity of injury to the spinal cord and to the vertebral column caused a significant increase in the mean LOS and CPS, and increasing total trauma load resulted in a significant increase in LOS and CPS. The LOS was shorter for patients admitted sooner after trauma. Respiratory, gastrointestinal, thromboembolic and genitourinary complications and decubitus ulceration were all associated with marked increases in LOS and CPS. The annual mean CPS decreased dramatically during the period of the study from 1974-81 due mainly to a decrease in LOS. Multiple regression analysis showed that severity and level of the spinal column and spinal cord injury, and the presence of complications had the most significant effects on duration and cost of care. The study also suggests that a specialized, multidisciplinary regional unit for ASCI patients is associated with a reduction in LOS and cost of care.