title: The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury.
abstract: OBJECTIVE
  To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI).
  
  
  METHODS
  Data from the Nationwide Inpatient Sample (2002-2011) were reviewed. Patients were included if they had a diagnosis of closed vertebral column fracture with SCI, underwent spine surgery, and were admitted urgently or emergently. Early intervention (the day of or the day after admission), inpatient morbidity and mortality rates were compared between patients admitted to teaching versus nonteaching hospitals. Multivariable regression analyses were performed.
  
  
  RESULTS
  A total of 9236 patients were identified (mean age 43 years, 82.6% male gender), with 78.7% admitted to a teaching hospital (n = 7,272) and 21.3% to a nonteaching hospital (n = 1,964). The most common mechanism of injury was a motor vehicle collision (43.9%), while the most common fracture location was between C5 and C7 (35.3%), and 22% of cases were complete SCIs. Following multivariable analysis, teaching hospital status was significantly associated with early intervention (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01-1.25), but not with complication development (OR, 1.09; 95% CI, 0.98-1.23) or mortality (OR, 1.19; 95% CI, 0.91-1.56).
  
  
  CONCLUSIONS
  In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching hospitals versus nonteaching hospitals for patients with SCI are encouraged.
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza Ramos
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nakhla
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Rani
authors.initials: R
authors.lastname: Nasser
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Ajit
authors.initials: A
authors.lastname: Jada
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Merritt D
authors.initials: MD
authors.lastname: Kinon
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA. Electronic address: ryassari@montefiore.org.
authors.forename: Reza
authors.initials: R
authors.lastname: Yassari
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000401:mortality* / Q000601:surgery*; D016103:Spinal Fractures / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: Nationwide Inpatient Sample; Spinal cord injury; Surgery; Teaching hospitals; Timing