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Pneumonia Prolongs Rehabilitation Length of Stay and Induces Excess Costs in Adults With Acute Spinal Cord Injury: A
Sven Mostberger1, Martin W G Brinkhof1, Boris Polanco1
1Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Objective:
To estimate the causal effect of pneumonia on the length of stay (LOS) and associated costs during inpatient rehabilitation following an acute spinal cord injury (SCI).
Design:
Prospective multicenter cohort study using a causal inference framework.
Setting:
Ten centers specialized in SCI rehabilitation in high-income countries.
Participants:
Newly injured SCI patients with complete or incomplete lesions at cervical or thoracic levels (C1-T12) admitted for inpatient rehabilitation. The study included adults (N=486), predominantly men (76.1%), with a median age of 55 years, who were roughly evenly divided between paraplegia (46.5%) and tetraplegia (53.5%).
Interventions:
Not applicable.
Main Outcome Measures:
Additional rehabilitation LOS and associated excess costs because of pneumonia.
Results:
Experiencing at least 1 episode of pneumonia was associated with an 11% increase in rehabilitation LOS on average. The resulting excess LOS was 21.3 days (95% confidence interval (CI), 18.9-23.7). The additional LOS because of pneumonia costs, on average, $41,812.57 (standard deviation 20,909.73) per patient. Patients with motor complete tetraplegia had the longest rehabilitation LOS, both with and without pneumonia (256.0d; 95% CI, 226.7-285.2 vs 228.9d; 95% CI, 201.6-256.2) and subsequential higher costs.
Conclusions:
Our findings indicate that pneumonia increases the average rehabilitation length of stay by 21 days and incurs additional costs exceeding $41,000 per patient in individuals with acute SCI. Early screening and prevention are essential to manage these impacts, especially in patients with motor complete tetraplegia.
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