Outcomes of Cervical Spine Surgery in Teaching and Non-Teaching Hospitals
Study Design. Retrospective national database analysis.Objective. A national population-based database was analyzed to characterize cervical spine procedures performed at teaching and non-teaching hospitals with regards to patient demographics, clinical outcomes/complications, resource utilization and costs.Summary of Background Data. There are mixed reports in the literature regarding the quality and costs of healthcare provided by teaching hospitals in the United States. However, outcomes of cervical spine surgery based upon teaching-status remains largely unknown.Methods. Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing elective anterior or posterior cervical fusion (ACF, PCF), or posterior cervical decompression (PCD; i.e. laminoforaminotomy, laminectomy, laminoplasty) for a diagnosis of cervical myelopathy and/or radiculopathy were identified and separated into two cohorts (teaching and non-teaching hospitals). Patient demographics, co-morbidities, complications, length of hospitalization, costs, and mortality were compared for both groups. Regression analysis was performed to assess independent predictors of mortality.Results. A total of 212,385 cervical procedures were identified from 2002-2009 in the United States, with 54.6% performed at teaching hospitals. More multilevel fusions and posterior approaches were performed in teaching hospitals (p<0.0005). Patients treated in teaching hospitals trended towards male gender, increased costs, and hospitalizations. Overall, procedure-related complications and in-hospital mortality were increased in teaching hospitals. Regression analysis revealed that significant predictors of mortality were age ≥ 65 (O.R. = 3.0) and multiple co-morbidities. Teaching status was not a significant predictor of mortality (p = 0.07).Conclusion. Patients treated in teaching hospitals for cervical spine surgery demonstrated longer hospitalizations, increased costs, and mortality over patients treated in non-teaching hospitals. Incidences of post-operative complications were identified as higher in teaching hospitals. Possible explanations for these findings are an increased complexity of procedures performed at teaching hospitals. Older age and presence of co-morbidities were more significant predictors of in-hospital mortality than teaching-status. Future studies should identify long-term complications and costs beyond an in-patient setting to assess if differences extend beyond the peri-operative period.
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