Urological Surveillance and Medical Complications After Spinal Cord Injury in the United States
Published in: Urology, 2015
OBJECTIVES: To evaluate national patterns of urologic follow up after SCI and the occurrence and predictors of urological complications. METHODS: This retrospective cohort study utilized a 5% sample of Medicare data 2007-2010. The minimum adequate urologic surveillance was defined as a: urologist visit; serum creatinine; and upper urinary tract imaging study within the two year period. Each patient was classified to their most severe complication in a multivariate linear regression model. RESULTS: Among the 7162 patients with SCI, the majority were functionally paraplegic (82.4%) and Caucasian (80.9%). 4.9% received no screening studies over the two year period, 70.5% received some, but not all screening and 24.6% received all three screening tests. Patients travelled a mean of 21.3 ±27.5 miles to receive care. A total of 35.7% of patients saw a urologist during the two year period, 48.6% had some form of upper tract evaluation, with the majority being CT scans and 90.7% had serum creatinine. Fully 35.8% of all patients had a minor complication during their two year follow up. 17.1% had a moderate complication and 8.0% had a severe complication. In our prediction model, patient factors that correlated with increased complications included male gender, African American race, paraplegia and receiving some or all of the NGB recommended screening. Patient distance of travel to their treating physician (urologist or physiatrist) did not affect the rate of complications. CONCLUSIONS: Urological complications are common in SCI who receive Medicare. Most of these patients with SCI are not receiving even the minimum recommended surveillance for these urological complications.