title: Impact of Hospital Teaching Status on Mortality, Length of Stay and Cost Among Patients With Cardiac Arrest in the United States.
abstract: Limited data exist regarding the in-hospital outcomes in patients with cardiac arrest (CA) in teaching versus nonteaching hospital settings. Using the Nationwide (National) Inpatient Sample (2008 to 2012), 731,107 cases of CA were identified using International Classification of Diseases, Ninth Edition codes. Among these patients, 348,368 (47.6%) were managed in teaching hospitals and 376,035 (51.4%) in nonteaching hospitals. Patients in teaching hospitals with CA were younger (62.42 vs 68.08 years old), had less co-morbidities (p <0.001), were less likely to be white (54.6% vs 65.5%) and more likely to be uninsured (9.1% vs 7.6%). Mortality in patients with CA was significantly lower in teaching hospitals than in nonteaching hospitals (55.3% vs 58.8%; all p <0.001). The mortality remained significantly lower after adjusting for baseline patient and hospital characteristics (odds ratio 0.917, CI 0.899 to 0.937, p <0.001). However, the survival benefit was no longer present after adjusting for in-hospital procedures (OR 0.997, CI 0.974 to 1.02, p = 0.779). In conclusion, teaching status of the hospital was associated with decreased in-hospital mortality in patients with CA. The differences in mortality disappeared after adjusting for in-hospital procedures, indicating that routine application of novel therapeutic methods in patients with CA in teaching hospitals could translate into improved survival outcomes.
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Elena V
authors.initials: EV
authors.lastname: Dolmatova
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Kasra
authors.initials: K
authors.lastname: Moazzami
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey; Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Marc
authors.initials: M
authors.lastname: Klapholz
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Neil
authors.initials: N
authors.lastname: Kothari
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Mirela
authors.initials: M
authors.lastname: Feurdean
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey; Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey. Electronic address: ahw22@njms.rutgers.edu.
authors.forename: Alfonso H
authors.initials: AH
authors.lastname: Waller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000191:economics / Q000401:mortality*; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology