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Chest. 2002 May;121(5):1548-54.

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

Author information

1
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

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.

PMID:
12006442
[Indexed for MEDLINE]

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