title: Effect of teaching hospital status on outcome of aneurysm treatment.
abstract: OBJECTIVE
  There is increasing literature supporting the importance in triaging patients to teaching hospitals for complex surgical procedures. This study analyzes the effect of teaching hospital status on outcome of endovascular coiling and microsurgical clipping of ruptured and unruptured intracranial aneurysms using the Nationwide Inpatient Sample database.
  
  
  METHODS
  We analyzed patients with cerebral aneurysms using the Nationwide Inpatient Sample 2001 to 2010. Patients with ruptured aneurysms were identified by International Classification of Diseases, 9th revision codes for diagnoses of subarachnoid hemorrhage or intracerebral hemorrhage and at least one procedural code for aneurysm repair. Patients with unruptured cerebral aneurysms were identified by diagnosis code 437.3 and at least one procedural code. Multivariate linear models were used to analyze the association of in-hospital death, nonroutine discharge, and length of stay with teaching hospital status, adjusting for patient age, sex, race, comorbidities, household income, time to aneurysm repair procedure, aneurysm procedure volume, hospital region, and location.
  
  
  RESULTS
  There were 34,843 hospitalizations for treatments of unruptured (14,763 in teaching and 1794 in nonteaching hospitals) and ruptured (15,628 in teaching and 2658 in nonteaching hospitals) aneurysms. In patients with ruptured aneurysms, the odds ratio of in-hospital death and nonroutine discharges were 0.69 (95% confidence interval 0.54-0.88) and 0.77 (95% confidence interval 0.60-0.99) in teaching hospitals, respectively, independent of hospital aneurysm procedure volume.
  
  
  CONCLUSIONS
  Our results suggest that the teaching status of a hospital is an independent factor for favorable outcome in the treatment of ruptured aneurysms. The difference in in-hospital death is accentuated in patients who underwent microsurgical clipping.
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Pui Man Rosalind
authors.initials: PM
authors.lastname: Lai
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: rdu@partners.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery; D016208:Databases, Factual; D023381:Endpoint Determination; D005260:Female; D006769:Hospitals, General / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Intracranial aneurysm; National Inpatient Sample; Outcomes; Subarachnoid hemorrhage; Teaching hospital