Anne P Cameron1, Julie Lai2, Christopher S Saigal3, J Quentin Clemens4. 1. Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: annepell@med.umich.edu. 2. RAND Corporation Santa Monica, CA. 3. Department of Urology, University of California in Los Angeles, Los Angeles, CA. 4. Department of Urology, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: To evaluate the national patterns of urologic follow up after spinal cord injury (SCI) and the occurrence and predictors of urological complications. MATERIALS AND METHODS: This retrospective cohort study used a 5% sample of Medicare data 2007-2010. The minimum adequate urologic surveillance was defined as a urologist visit, serum creatinine evaluation, and upper urinary tract imaging study within the 2-year period. Patients were 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%). Among them, 4.9% received no screening studies over the 2-year period; 70.5% received some, but not all screening; and 24.6% received all three screening tests. Patients traveled a mean of 21.3 ± 27.5 miles to receive care. A total of 35.7% of patients saw a urologist during the 2-year period; 48.6% had some form of upper tract evaluation, with the majority being computed tomography scans; and 90.7% had serum creatinine evaluation. Of all patients, 35.8% had a minor complication during their 2-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 neurogenic bladder recommended screening. Patients' distance of travel to their treating physician (urologist or physiatrist) did not affect the rate of complications. CONCLUSION: Urological complications are common in patients with SCI who receive Medicare. Most of these patients with SCI are not receiving even the minimum recommended surveillance for these urological complications.
OBJECTIVE: To evaluate the national patterns of urologic follow up after spinal cord injury (SCI) and the occurrence and predictors of urological complications. MATERIALS AND METHODS: This retrospective cohort study used a 5% sample of Medicare data 2007-2010. The minimum adequate urologic surveillance was defined as a urologist visit, serum creatinine evaluation, and upper urinary tract imaging study within the 2-year period. Patients were 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%). Among them, 4.9% received no screening studies over the 2-year period; 70.5% received some, but not all screening; and 24.6% received all three screening tests. Patients traveled a mean of 21.3 ± 27.5 miles to receive care. A total of 35.7% of patients saw a urologist during the 2-year period; 48.6% had some form of upper tract evaluation, with the majority being computed tomography scans; and 90.7% had serum creatinine evaluation. Of all patients, 35.8% had a minor complication during their 2-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 neurogenic bladder recommended screening. Patients' distance of travel to their treating physician (urologist or physiatrist) did not affect the rate of complications. CONCLUSION: Urological complications are common in patients with SCI who receive Medicare. Most of these patients with SCI are not receiving even the minimum recommended surveillance for these urological complications.
Authors: Anne P Cameron; Lauren P Wallner; Martin B Forchheimer; J Quentin Clemens; Rodney L Dunn; Gianna Rodriguez; David Chen; John Horton; Denise G Tate Journal: Arch Phys Med Rehabil Date: 2011-01-31 Impact factor: 3.966
Authors: Paul Abrams; Meena Agarwal; Marcus Drake; Waghi El-Masri; Simon Fulford; Sheilagh Reid; Gurpreet Singh; Paul Tophill Journal: BJU Int Date: 2008-02-15 Impact factor: 5.588
Authors: Suzanne L Groah; David A Weitzenkamp; Daniel P Lammertse; Gale G Whiteneck; Dennis C Lezotte; Richard F Hamman Journal: Arch Phys Med Rehabil Date: 2002-03 Impact factor: 3.966
Authors: Jacinthe J E Adriaansen; Floris W A van Asbeck; Helma M H Bongers-Janssen; Dorien Spijkerman; Johanna M A Visser-Meily; Laetitia M O de Kort; Marcel W M Post Journal: Top Spinal Cord Inj Rehabil Date: 2017