The Cost of Preventable Conditions in Adults with Spina Bifida

Adults with spina bifida are at risk of developing secondary health conditions that are causally related to the primary condition and are to some degree preventable. By investigating preventable secondary conditions in adults with spina bifida, we can determine the burden of care that might be reduced if preventive strategies were developed. We audited hospitalizations of adults with spina bifida to gain insight into serious secondary conditions in this population. We reviewed all admissions of adults with spina bifida to a large American tertiary care center (Johns Hopkins Hospital; Baltimore, Maryland) over 11 years. We determined the discharge diagnoses for each admission and the hospital costs associated with admission. We defined preventable secondary conditions in this adult population and calculated the percentage of total admissions and of total costs for these secondary conditions. The patient population consisted of spina bifida patients 18 years and over admitted from January 1982 to December 1992, including 59 females and 39 males. 77 of our patients were identified as white, 20 as black, and 1 as "other". Patient age ranged from 18 to 61 years with an average age of 25. 8 years. There were 353 admissions and admissions per patient ranged from 1 to 25 over the 11-year period. The average number of admissions per patient was 3. 6 and the average length of stay for all admissions was 11. 2 days. Of the 353 total admissions, 166 (47. 0%) were due to potentially preventable secondary conditions such as serious urologic infections, renal calculi, pressure ulcers, and osteomyelitis. For admissions due to these secondary conditions, the average length of stay was 12. 5 days. The total hospital costs, excluding professional fees, were 175, 885, 247, 355, and 437, 262 for 1990, 1991, and 1992 respectively. Permanent loss of function resulting from secondary conditions, not investigated in this study, can also be a source of long-term financial and psychological cost to the patient. This study found a high number of patients with multiple admissions and that many admissions qualified as potentially preventable. More information is needed if we are to understand the factors associated with secondary health conditions in adults with spina bifida. We need to investigate the roles played by physician and patient knowledge, attitudes, and behaviors in contributing to patient outcome.