Causes and length of stay of readmission among individuals with traumatic spinal cord injury: a prospective observational cohort study
Authors: Franceschini Marco , Cecconi Lorenzo , Bonavita Jacopo , Pournajaf Sanaz , Ferro Salvatore , Pagliacci Maria Cristina ,   the Italian SCI Study Group,   Steering Committee, Ferro Salvatore , Bellentani Maria donate , Franceschini Marco , Cavina Augusto , Bonavita Jacopo , Pagliacci Maria Cristina , Biggeri Annibale , Cecconi Lorenzo , De Iure Federico , Gordini Giovanni , Redaelli Tiziana , Actis Maria Vittoria , Del Popolo Giulio , Bertagnoni Giannettore , Avesani Renato , Falabella Vincenzo ,   Collaborating Hospitals and Regional Health Authorities, Actis M. V. , Stillittano M. , Petrozzino S. , Cisari C. , Salvini M. , Redaelli T. , Tosi R. , Borghi C. M. , Bava A. , Pistarini C. , Molinero G. , Signorelli A. , Sandri S. , Simeoni F. , Brambilla M. , Banchero M. A. , Olivero A. , Zanaboni G. , Avesani R. , Bertagnoni G. , Leucci M. , Lain L. , Saia M. , Zampa A. , Del Fabro P. , Saccavini M. , Fanzutto A. , Massone A. , Bonavita J. , Gaddoni D. , Olivi S. , Musumeci G. , Pederzini R. , CerrelBazo H. , Nicolotti D. , Nora M. , Brianti R. , Iaccarino C. , Volpi A. , Lombardi A. , Cavazza S. , Casoni F. , De Iure F. , Gordini G. , Piperno R. , Teodorani G. , Naldi A. , Vergoni G. , Maietti E. , Botti A. , Ferro S. , Pagoto G. , Del Popolo G. , Moresi M. , Postiglione M. , Bini C. , Tagliaferri M. , Recchioni M. A. , Pelaia P. , Di Furia L. , Pagliacci M. C. , Maschke R. , Caruso L. , Speziali L. , Zenzeri M. , Fiore P. , Marvulli R. , Nardulli R. , Lanzillotti C. , Ruccia M. , Onesta M. P. , Di Gregorio T. , Franchina F. , Furnari M. G. , Pilati C. , Merafina M. , Crescia F. , Fletzer D. , Scivoletto G. , Di Lallo N. 
Published: February 2023

Abstract
Background
Secondary conditions may reduce function and participation in individuals with chronic Spinal Cord Injury (SCI). The knowledge of reasons for readmission to the hospital may be enlightening to prevent them and remodel the health services.

Study design
Multicenter prospective observational study of all consecutive readmissions of persons with SCI after rehabilitation completion.

Objectives
To explore the characteristics of individuals with SCI readmitted to the hospital, the reasons for readmissions and the burden on hospitalization in terms of length of stay (LoS) for different conditions.

Setting
31 Italian specialized SCI centers.

Methods
Data on people with traumatic SCI readmitted to SCI centers were recorded about: age, sex, SCI level and severity group, geographical origin, readmission causes, clinical interventions during hospitalization, LoS and discharge destination. Linear and multiple logistic regression analyses were performed considering LoS (days) as dependent variable for correlations with independent variables. All tests were two-sided.

Results
Among 1039 persons with traumatic SCI enrolled (mean age 46, males 85%, tetraplegia 43%), 59.09% of the readmissions were caused by urological problems, 39.74% by pressure injury and 35.41% by spasticity (68% readmitted for ≥2 causes, associated with longer LoS). The mean LoS was 48 days: pressure injury, rehabilitative needs, sexual, bowel, and pain problems were associated with longer and urological problems with shorter LoS. People from the South of the country were frequently (68%) readmitted to the northern centers.

Conclusions
Urological problems, pressure injury and spasticity were the most frequent causes of re-hospitalization in individuals with traumatic SCI. The migration trend seeking SCI-specific treatments suggests geographic areas to which health care organizations need to pay more attention.