Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury.
BACKGROUND
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.


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


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


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


METHODS
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.
Winslow
Christopher
C
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University and The Rehabilitation Institute of Chicago, Chicago, IL 60611, USA. c-winslow@northwestern.edu
Bode
Rita K
RK
Felton
Dan
D
Chen
David
D
Meyer
Paul R
PR
D000208:Acute Disease; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D012131:Respiratory Insufficiency / Q000191:economics* / Q000209:etiology / Q000628:therapy; D012141:Respiratory Tract Infections / Q000191:economics* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000191:economics