Health outcomes and costs of acute traumatic spinal injury in New South Wales, Australia

Rebecca Mitchell, Lara Harvey, Ralph Stanford, Jacqueline Close

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background Context: Traumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level.

Purpose: The present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people.

Study Design/Setting: This is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia.

Patient Sample: The present study included 13,429 hospitalizations.

Outcome Measures: Mortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined.

Methods: Hospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days.

Results: There were 13,429 hospitalizations, with 52.4% of individuals aged ≥65 years. The hospitalization rates for individuals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97–5.79, p<.006) and 3.3% (95% CI 1.02–5.71, p=.005), respectively. For individuals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than individual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for individuals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility.

Conclusions: Spinal injury represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger individuals, prevention measures should target road safety.

LanguageEnglish
Pages1172-1179
Number of pages8
JournalSpine Journal
Volume18
Issue number7
DOIs
Publication statusPublished - Jul 2018

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Spinal Injuries
South Australia
New South Wales
Health Care Costs
Hospitalization
Length of Stay
Costs and Cost Analysis
Homes for the Aged
Wounds and Injuries
Mortality
Spinal Cord Injuries
Spinal Fractures
Confidence Intervals
Patient Readmission
Injury Severity Score
Hospital Costs
Health
Population
Comorbidity
Epidemiologic Studies

Keywords

  • Epidemiology
  • Falls
  • Fracture
  • Motor vehicle crashes
  • Spinal injury
  • Treatment costs

Cite this

Mitchell, Rebecca ; Harvey, Lara ; Stanford, Ralph ; Close, Jacqueline. / Health outcomes and costs of acute traumatic spinal injury in New South Wales, Australia. In: Spine Journal. 2018 ; Vol. 18, No. 7. pp. 1172-1179.
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Health outcomes and costs of acute traumatic spinal injury in New South Wales, Australia. / Mitchell, Rebecca; Harvey, Lara; Stanford, Ralph; Close, Jacqueline.

In: Spine Journal, Vol. 18, No. 7, 07.2018, p. 1172-1179.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Harvey, Lara

AU - Stanford, Ralph

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N2 - Background Context: Traumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level. Purpose: The present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people. Study Design/Setting: This is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia. Patient Sample: The present study included 13,429 hospitalizations. Outcome Measures: Mortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined. Methods: Hospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days. Results: There were 13,429 hospitalizations, with 52.4% of individuals aged ≥65 years. The hospitalization rates for individuals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97–5.79, p<.006) and 3.3% (95% CI 1.02–5.71, p=.005), respectively. For individuals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than individual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for individuals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility. Conclusions: Spinal injury represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger individuals, prevention measures should target road safety.

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