Genitourinary Complications Are a Leading and Expensive Cause of Emergency Department and Inpatient Encounters for Persons With Spinal Cord Injury

Arch Phys Med Rehabil. 2019 Sep;100(9):1614-1621. doi: 10.1016/j.apmr.2019.02.013. Epub 2019 Mar 30.


Objectives: To determine the rates of emergency department (ED) visits and inpatient hospitalizations for genitourinary (GU) complications after spinal cord injury (SCI) using a national sample; to examine which patient and facility factors are associated with inhospital mortality; and to estimate direct medical costs of GU complications after SCI.

Design: Retrospective cross-sectional and cost analysis of the 2006 to 2015 National Inpatient Sample and National Emergency Department Sample from the Healthcare Cost and Utilization Project.

Participants: SCI-related encounters using various International Classification of Disease, Ninth Edition, Clinical Modification diagnosis codes. The inpatient sample included 1,796,624 hospitalizations, and the ED sample included 618,118 treat-and-release visits.

Main outcome measures: The exposure included a GU complication, identified by International Classification of Disease, Ninth Edition, Clinical Modification codes 590-599. The outcomes then included an ED visit or hospitalization, death prior to discharge, and direct medical costs estimated from reported hospital charges.

Results: For the inpatient sample, we observed a 2.5% annual increase (95% confidence interval [CI], 1.8-3.2) in the proportion of SCI-related hospitalizations with any GU complication from 2006 to 2011, and a lesser rate of increase of 0.9% (95% CI, 0.4-1.4) each year from 2011 to 2015. Age, level of injury, and payer source were correlated to inhospital mortality. The costs of GU-related health care use exceeded $4 billion over the study period.

Conclusions: This study shows the rates and economic burden of health care use associated with GU complications in persons with SCI in the United States. The need to develop strategies to effectively deliver health care to the SCI population for these conditions remains great.

Keywords: Neurogenic bladder; Rehabilitation; Spinal cord injury.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Female Urogenital Diseases / economics
  • Female Urogenital Diseases / etiology*
  • Female Urogenital Diseases / therapy
  • Health Care Costs / statistics & numerical data*
  • Hospital Mortality
  • Hospitalization / statistics & numerical data*
  • Hospitalization / trends
  • Humans
  • Male
  • Male Urogenital Diseases / economics
  • Male Urogenital Diseases / etiology*
  • Male Urogenital Diseases / therapy
  • Middle Aged
  • Paraplegia / etiology
  • Quadriplegia / etiology
  • Retrospective Studies
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / mortality
  • United States
  • Young Adult