Pneumonia Prolongs Rehabilitation Length of Stay and Induces Excess Costs in Adults With Acute Spinal Cord Injury: A Causal Inference Study Using Prospective Multicenter Data.

Abstract

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.