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.

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.