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Clinical Investigations: MUSCULOSKELETAL |

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

Christopher Winslow, MD; Rita K. Bode, PhD; Dan Felton, BS; David Chen, MD; Paul R. Meyer, Jr, MD
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Dr. Winslow), Department of Medicine, the Department of Physical Medicine and Rehabilitation (Drs. Bode and Chen, and Mr. Felton), and the Department of Orthopedic Surgery (Dr. Meyer), Northwestern University and The Rehabilitation Institute of Chicago, Chicago, IL.

Correspondence to: Christopher Winslow, MD, Rehabilitation Institute of Chicago, Room 358, 345 East Superior St, Chicago, IL 60611; e-mail: c-winslow@northwestern.edu



Chest. 2002;121(5):1548-1554. doi:10.1378/chest.121.5.1548
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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.

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