Predictors of Length of Stay in Patients with Spinal Cord Injury

Abstract

Purpose: SCI are one of the leading causes of disabilities around the world. Length of stay in patients with spinal cord injury depends on many medical and non-medical factors, especially of health-care system and social environment.

Material and Method: The study included 529 patients with spinal cord injuries admitted in Clinic for rehabilitation “Dr M. Zotovic”, Belgrade, Serbia, from January 2000 to December 2009. The factors influencing length of stay in our study were: age, gender, neurological level and completeness of injury, etiology of injury, methods of treatment, secondary complications and associated injuries. Length of stay in this study was defined from the date of admission to the date of discharge from rehabilitation.

Results: Median length of rehabilitation is 134 days (range, 28.0–533.0). The average age of survey respondents was 46.1±16.8 years. In this study 382 (72.2%) of patients were male and 147 (27.8%) were female. There were 180 (34.0%) tetraplegic and 349 (66%) paraplegic patients. In the multivariate Cox regression model, statistically significant predictors of length of stay were: neurological level of injury (p=0.014), completeness of the lesion (p=0.048), ASIA scale (p<0.001), age (p=0.043), urinary tract infection (p<0.001) and spasticity (p=0.042) as complications during rehabilitation.

Conclusion: Reducing the length of stay would significantly decrease the overall financial costs for patients with spinal cord injury. Construction of the specialized centers for rehabilitation of patients with spinal cord injury and better coordination between primary care and rehabilitation centers would contribute to it.

Zusammenfassung

Ziel: Rückenmarksverletzungen gehören weltweit zu den Hauptursachen für Behinderungen. Die Verweildauer von Patienten mit Rückenmarksverletzung hängt von vielen medizinischen und nichtmedizinischen Faktoren ab, insbesondere vom Gesundheitssystem und dem sozialen Umfeld.

Material und Methode: In die Studie wurden 529 Patienten mit Rückenmarksverletzung eingeschlossen, die in die Rehabilitationsklinik „Dr. M. Zotovic“ in Belgrad, Serbien, zwischen Januar 2000 und Dezember 2009 eingewiesen worden waren. Die Einflussfaktoren in unserer Studie auf die Verweildauer waren: Alter, Geschlecht, Höhe und Ausmaß der Läsion, Ätiologie der Verletzung, Behandlungsmethoden, Sekundärkomplikationen und Begleitverletzungen. Die Verweildauer war in dieser Studie definiert als Zeitraum vom Datum der Einweisung bis zum Datum der Entlassung aus der Rehabilitation.

Ergebnisse: Die mittlere Verweildauer in der Rehabilitation lag bei 134 Tagen (Bereich: 28,0–533,0) Das mittlere Alter der Studienteilnehmer betrug 46,1±16,8 Jahre. In dieser Studie waren 382 (72,2%) der Patienten männlich und 147 (27,8%) weiblich. 180 (34,0%) der Patienten hatten eine hohe Querschnittlähmung (Tetraplegie) und 349 (66%) eine Paraplegie. Im multivariaten Cox-Regressionsmodel waren die statistisch relevanten Pradiktoren auf die Verweildauer: Läsionshöhe (p=0,014), Ausmaß der Läsion (p=0,048), AIS Skala (p<0,001), Alter (p=0,043), Harnwegsinfektion (p<0,001) und Spastik (p=0,042) als Komplikationen während der Rehabilitation.

Schlussfolgerung: Eine Verringerung der Verweildauer würde die Gesamtkosten für Patienten mit Rückenmarksverletzungen signifikant senken. Die Einrichtung von spezialisierten Rehabilitationszentren für Patienten mit Rückenmarksverletzung und eine bessere Koordination zwischen Erstversorgung und Rehabilitationszentrum würden dazu beitragen.

Key words

spinal cord lesions - length of stay - prediction - rehabilitation

Schlüsselwörter

Rückenmarksverletzungen - Verweildauer - Prädiktion - Rehabilitation

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