title: Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals.
abstract: OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82-0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.affiliation: Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: Division of Spinal Surgery, NYU Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010027:Osteotomy / Q000009:adverse effects* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013121:Spinal Curvatures / Q000401:mortality* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D013131:Spine / Q000601:surgery; D016896:Treatment Outcome
keywords: ASD = adult spinal deformity; LOS = length of stay; NIS = Nationwide Inpatient Sample; Nationwide Inpatient Sample; adult spinal deformity; complications; mortality; teaching hospital