Injury hospitalizations and associated costs between individuals with pre-existing quadriplegia versus paraplegia

Purpose: To compare the differences in injury hospitalizations, including length of stay (LOS) and hospital costs, between individuals with pre-existing quadriplegia versus paraplegia, and determine factors associated with increased hospital costs. Methods: A retrospective cohort of injury hospitalizations among individuals with pre-existing quadriplegia or paraplegia in the Nationwide Inpatient Sample (2003-2009) was analyzed. Differences between patients with quadriplegia versus paraplegia in cause of subsequent injury, LOS, and hospital costs were compared using chi-square tests or independent t-test. Multivariable linear regression was conducted to estimate mean difference in hospital costs for injury hospitalizations among individuals with quadriplegia compared to paraplegia. Results: Over the seven-year period, national injury hospitalizations were 12,565 and 15,551 for individuals with pre-existing quadriplegia and paraplegia, respectively (an average of 1,795 and 2,222 per year). Over one-third of injury hospitalizations were due to falls. Patients who died were significantly more likely to be individuals with quadriplegia versus paraplegia. Despite fewer injury hospitalizations overall, individuals with quadriplegia have longer LOS, and higher average and total costs for injury hospitalizations due to falls and motor vehicle traffic, but similar outcomes for poisonings compared to individuals with paraplegia. Hospital costs also increased significantly for uninsured individuals or those with 2 or more comorbidities, compared to those covered by Medicare/Medicaid or without other comorbidities. Conclusions: Fewer injury hospitalizations, but longer hospital stays and higher hospital costs per discharge, were found for individuals with quadriplegia compared to individuals with paraplegia. Interventions to prevent subsequent injuries in this special population are urgently needed.