Changing Case‐Mix and Inpatient Rehabilitation Costs in C4/C5 Traumatic Cervical Spinal Cord Injury: A 10‐Year Single‐Center Study From a National Rehabilitation Center in China

Background The case‐mix and inpatient rehabilitation costs of traumatic cervical spinal cord injury (TCSCI) may have shifted with population aging and the coronavirus disease 2019 (COVID‐19) pandemic. We examined decade‐long trends in patient characteristics, injury mechanisms, and per‐diem rehabilitation costs for neurological‐level C4/C5 TCSCI. Methods All patients with C4/C5 TCSCI admitted to the China Rehabilitation Research Center were studied retrospectively, comparing 2013–2017 with 2018–2022, and, in an exploratory analysis, the pre‐pandemic (2018–2019) with the pandemic (2020–2022) period. Costs were adjusted for inflation using the medical services Consumer Price Index. Comparisons used the χ 2 , Wilcoxon rank‐sum, and Kruskal–Wallis tests. Cost drivers were modeled using multivariable Gamma generalized linear models (log link). Results Among 1063 patients (male‐to‐female ratio 5.3:1), mean age rose from 43.9 to 49.5 years and the proportion injured by low‐level falls increased from 20.7% to 33.8% ( χ 2 = 37.76, p < 0.001). Length of stay decreased ( Z = −2.33, p = 0.02) while adjusted daily cost increased ( Z = −10.07, p < 0.001; median 1330 RMB, interquartile range 908–1780, [USD 215]). In constant 2013 prices a real increase persisted (+12.5%, p < 0.001), and the later period remained independently associated with higher daily cost after case‐mix adjustment (adjusted cost ratio 1.15, 95% CI 1.07–1.24). Conclusions Admitted patients were increasingly older and frequently injured in low‐level falls. Per‐diem rehabilitation costs rose despite shorter hospital stays. Changes spanning the pandemic represent an exploratory temporal association rather than causal evidence. Fall prevention strategies for older adults and capacity planning for higher‐dependency rehabilitation are warranted.