Long-term Complication Rates and Healthcare Utilization After Traumatic Spinal Cord Injury Are More Strongly Associated with Insurance Status than Injury Mechanism

Abstract Background Injury mechanism influences early neurologic recovery after SCI, but long-term outcomes may also depend on access to post-acute care. The relative contributions of injury etiology and insurance status remain unclear. This retrospective longitudinal cohort study compares long-term complications and healthcare utilization after spinal cord injury (SCI) due to gunshot wounds (GSW) versus motor vehicle accidents (MVA) and evaluates the effect of insurance status on these outcomes. Methods Adults with traumatic SCI due to GSW or MVA who completed inpatient rehabilitation were followed at 2 and 5 years post-discharge. Baseline demographics, injury characteristics, operative management, rehabilitation length of stay, and insurance class were recorded. Outcomes included medical complications and healthcare utilization, including outpatient encounters, physical therapy visits, hospitalizations, emergency department visits, imaging, and procedures. Adjusted generalized linear models controlled for age, sex, neurologic level, ASIA impairment category, comorbidity burden, rehabilitation exposure, and operative status. Results Sixty-six patients were evaluated at 2 years (31 GSW, 35 MVA), with 50 available at 5 years. After adjustment, total complication counts did not differ by injury mechanism at either time point. Insurance status was strongly associated with outcomes. Compared with private insurance, Medicaid/Medicare coverage was associated with higher complication counts and greater emergency department use, hospitalizations, imaging, and procedures, with lower physical therapy utilization. No-Fault Auto coverage was associated with greater outpatient and therapy utilization and lower reliance on acute care services. These associations persisted after adjustment. Conclusions Long-term complication burden did not differ by injury mechanism. Insurance status was independently associated with healthcare utilization and complication burden through 5 years, suggesting that differences in access to post-acute care influence long-term outcomes after SCI.