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

Chest. 2002 May;121(5):1548-54. doi: 10.1378/chest.121.5.1548.

Abstract

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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Disease
  • Adult
  • Cervical Vertebrae / injuries*
  • Hospital Costs*
  • Humans
  • Length of Stay / economics*
  • Respiratory Insufficiency / economics*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy
  • Respiratory Tract Infections / economics*
  • Respiratory Tract Infections / etiology
  • Respiratory Tract Infections / therapy
  • Retrospective Studies
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / economics