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

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 dining the initial acute-care hospitalization for CSI is a more important determinant of LOS and hospital costs than level of injury.