title: Urological Surveillance and Medical Complications after Spinal Cord Injury in the United States.
abstract: OBJECTIVE
  To evaluate the national patterns of urologic follow up after spinal cord injury (SCI) and the occurrence and predictors of urological complications.
  
  
  METHODS
  This retrospective cohort study used a 5% sample of Medicare data 2007-2010. The minimum adequate urologic surveillance was defined as a urologist visit, serum creatinine evaluation, and upper urinary tract imaging study within the 2-year period. Patients were classified to their most severe complication in a multivariate linear regression model.
  
  
  RESULTS
  Among the 7162 patients with SCI, the majority were functionally paraplegic (82.4%) and Caucasian (80.9%). Among them, 4.9% received no screening studies over the 2-year period; 70.5% received some, but not all screening; and 24.6% received all three screening tests. Patients traveled a mean of 21.3 ± 27.5 miles to receive care. A total of 35.7% of patients saw a urologist during the 2-year period; 48.6% had some form of upper tract evaluation, with the majority being computed tomography scans; and 90.7% had serum creatinine evaluation. Of all patients, 35.8% had a minor complication during their 2-year follow up, 17.1% had a moderate complication, and 8.0% had a severe complication. In our prediction model, patient factors that correlated with increased complications included male gender, African American race, paraplegia, and receiving some or all of the neurogenic bladder recommended screening. Patients' distance of travel to their treating physician (urologist or physiatrist) did not affect the rate of complications.
  
  
  CONCLUSIONS
  Urological complications are common in patients with SCI who receive Medicare. Most of these patients with SCI are not receiving even the minimum recommended surveillance for these urological complications.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: annepell@med.umich.edu.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Cameron
authors.affiliation: RAND Corporation Santa Monica, CA.
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.affiliation: Department of Urology, University of California in Los Angeles, Los Angeles, CA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D020380:Needs Assessment; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D014481:United States / Q000453:epidemiology; D014570:Urologic Diseases / Q000175:diagnosis* / Q000453:epidemiology*