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. 2025 Sep;48(5):891-900.
doi: 10.1080/10790268.2024.2375892. Epub 2024 Jul 22.

Polypharmacy in spinal cord injury: Matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up

Nicholas Dietz  1 , Victoria Alkin  1 , Nitin Agarwal  2 , Martin Flores Bjurström  3 , Beatrice Ugiliweneza  1 , Dengzhi Wang  1 , Mayur Sharma  1 , Doniel Drazin  4 , Maxwell Boakye  1
Affiliations

Polypharmacy in spinal cord injury: Matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up

Nicholas Dietz et al. J Spinal Cord Med. 2025 Sep.

Abstract

Objective: Polypharmacy in spinal cord injury (SCI) is common and predisposes patients to increased risk of adverse events. Evaluation of long-term health consequences and economic burden of polypharmacy in patients with SCI is explored.

Design: Retrospective cohort.

Methods: The IBM Marketscan Research Databases claims-based dataset was queried to search for adult patients with SCI with a 2-year follow-up.

Participants: Two matched cohorts were analyzed: those with and without polypharmacy, analyzing index hospitalization, readmissions, payments, and health outcomes.

Results: A total of 11 569 individuals with SCI were included, of which 7235 (63%) were in the polypharmacy group who took a median of 11 separate drugs over two years. Opioid analgesics were the most common medication, present in 57% of patients with SCI meeting the criteria of polypharmacy, followed by antidepressant medications (46%) and muscle relaxants (40%). Risk of pneumonia was increased for the polypharmacy group (58%) compared to the non-polypharmacy group (45%), as were urinary tract infection (79% versus 63%), wound infection (30% versus 21%), depression (76% versus 57%), and adverse drug events (24% versus 15%) at 2 years. Combined median healthcare payments were higher in polypharmacy at 2 years ($44 333 vs. $10 937, P < .0001).

Conclusion: Majority of individuals with SCI met the criteria for polypharmacy with nearly 60% of those prescribed opioids and taking drugs from high-risk side effect profiles. Polypharmacy in SCI was associated with a greater risk of pneumonia, depression, urinary tract infections, adverse drug events, and emergency room visits over two years with four times higher overall healthcare payments at 1-year post-injury.

Keywords: Adverse events; Healthcare utilization; Polypharmacy; Spinal cord injury.

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Figures

Figure 1
Figure 1
Payments at 24 months post-injury overall based on location and severity of injury cohorts.
See this image and copyright information in PMC

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