119 - Outcomes of Cervical Spine Surgery in Teaching and Non-teaching Hospit...

#119 Outcomes of Cervical Spine Surgery in Teaching and Non-teaching Hospitals

Epidemiology-Natural History

Poster Presented by: K. Singh

Author(s):

M. Pelton (1)
S.J. Fineberg (1)
M. Oglesby (1)
K. Singh (1)
A. Patel (2)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, USA
(2) Northwestern University Feinberg School of Medicine, Orthopaedic Surgery, Chicago, IL, USA

Abstract

Introduction: Anterior cervical fusion (ACF), posterior cervical fusion (PCF), and posterior cervical decompression (PCD) are commonly performed procedures in both academic and private settings. Perception biases exist with regards to complications and costs based upon the hospital environment. To characterize these differences on a national level, a population-based database was analyzed with regards to patient demographics, clinical outcomes/complications, resource utilization and costs.

Methods: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was obtained for each year from 2002-2009. Patients undergoing ACF, PCF, and PCD (i.e. laminoforaminotomy, laminectomy, laminoplasty) for the diagnosis of cervical radiculopathy and myelopathy were identified and separated into two cohorts (Teaching and Non-teaching hospitals). Patient demographics (e.g., age, gender) and co-morbidities (e.g., diabetes) were compared. Major complications, length of hospitalization, and costs were assessed for both groups. Independent-Samples T test was used to assess for significant differences. Regression analysis was performed to assess independent predictors of in-hospital mortality. Statistical analysis was conducted using SPSS v.20. A p-value of < 0.0005 was used to denote statistical significance.

Results: A total of 273,396 cervical procedures were identified between 2002 and 2009 in the United States for the diagnosis of cervical myelopathy/radiculopathy. Patients treated in teaching hospitals trended towards increased costs, co-morbidity scores, length of hospitalization, African-American ethnicity, male gender, and private insurance payer status (Table 1). Procedure-related complications of thromboembolic events (DVT, PE), infection, hematoma, cardiac, urinary, and neurologic complications and in-hospital mortality were also higher in teaching hospitals after ACFs. DVT, neurologic complications, and mortality were higher in PCFs performed at teaching hospitals. Peri-operative complications and mortality did not differ significantly after PCD. Regression analysis revealed that significant predictors of mortality were male gender (Odds Ratio= 1.9), teaching hospital status (Odds Ratio= 1.4), emergent/urgent admission status (Odds Ratio= 2.8), and co-morbidities of congestive heart failure, coagulopathy, renal failure, weight loss, paralysis, and other neurologic disorders.

Discussion: Patients treated in teaching hospitals for cervical spine surgery have greater co-morbidities, are more likely to be the result of traumatic injury, and are more likely to be emergent or urgent admissions. These patients demonstrate longer hospitalizations, increased costs, and increased mortality over patients treated in non-teaching hospitals. Incidences of post-operative complications were also identified as higher in teaching hospitals. Possible explanations for these increases are the increased complexity of patients being treated in the academic setting and higher volumes of patients being treated in academic institutions. Our analysis confirmed that male gender, presence of co-morbidities, and emergent cases are more significant predictors of in-hospital mortality than teaching status. Future studies should identify long-term complications and costs of patients within and outside of a teaching hospital setting to assess if these outcomes extend beyond the peri-operative time course.

Table 1