Rehabilitation length of stay in individuals with spinal cord injury in Switzerland: A population-based study

INTRODUCTION: The length of stay (LOS) for inpatient SCI rehabilitation varies widely worldwide, including high-income countries. Understanding the individual factors that influence LOS at the country level provides valuable insights for optimizing rehabilitation services and resource allocation. Currently, representative data on LOS in rehabilitation following SCI in Switzerland are lacking. OBJECTIVE: To provide a population-based description of rehabilitation LOS and its determinants after SCI in Switzerland. METHODS: This study utilized data from the Swiss Spinal Cord Injury inception cohort, comprising individuals admitted to specialized rehabilitation between 2020 and 2023. Missingness was addressed using multiple imputation. Flexible parametric survival models were employed to identify significant relationships between rehabilitation LOS and the following determinants: patient and lesion characteristics, comorbidity status, functional independence at admission, common secondary health conditions (urinary tract infection, decubitus ulcers, and pneumonia), LOS in acute care, and rehospitalization. RESULTS: The main analysis included 831 individuals with SCI, revealing a median LOS of 139 days (IQR 79.0-189.0). Independent associations with rehabilitation LOS identified in the fully adjusted model included age at SCI, level and lesion severity, urinary tract infections, decubitus ulcers, and functional independence at admission. Additionally, pneumonia and rehospitalization were significantly associated with LOS in supplementary expanded analyses based on a larger sample size with increased power. CONCLUSION: This study described the LOS for SCI rehabilitation in Switzerland and identified critical patient- and lesion-related determinants. The insights gained are instrumental for healthcare providers and policymakers in enhancing the efficiency and quality of SCI rehabilitation services.