Urological Surveillance and Medical Complications after Spinal Cord Injury in the United States

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Study assessed national patterns of urologic follow-up after spinal cord injury (SCI) to determine how many received adequate surveillance and evaluated the occurrence and predictors of urological complications. The minimum adequate urologic surveillance was defined as: (1) a urologist visit, (2) serum creatinine evaluation, and (3) upper urinary tract imaging study within the 2-year period. Patients were classified to their most severe complication in a multivariate linear regression model. Of the 7,162 Medicare patients with SCI included in the analysis, 4.9 percent received no screening studies over the 2-year study period; 70.5 percent received some, but not all screening; and 24.6 percent received all 3 screening tests. Patients traveled a mean of 21.3 miles to receive care. A total of 35.7 percent of patients saw a urologist during the 2-year period; 48.6 percent had some form of upper tract evaluation, with the majority being computed tomography scans; and 90.7 percent had serum creatinine evaluation. Among all patients, 35.8 percent had a minor complication during their 2-year follow up, 17.1 percent had a moderate complication, and 8.0 percent had a severe complication. In the 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 did not affect the rate of complications. Findings suggest that urological complications are common in Medicare patients with SCI; however, most of these patients are not receiving even the minimum recommended surveillance for these complications.

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