345 - Outcomes of Lumbar Spine Surgery in Teaching and Non-teaching Hospital...

#345 Outcomes of Lumbar Spine Surgery in Teaching and Non-teaching Hospitals: Analysis of the “July Effect”

Lumbar Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

S.V. Nandyala (1)
A.J. Marquez-Lara (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: The influx of new residents at the beginning of the academic year, in July, may impact lumbar spine surgery outcomes. A population-based database was analyzed to characterize patients in July in terms of the demographics, hospital course, costs, and mortality associated with lumbar spinal intervention in teaching and non-teaching institutions.

Methods: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002-2011. Patients who underwent a lumbar decompression (LD) or lumbar fusion (LF) in teaching and non-teaching hospitals for symptomatic lumbar radiculopathy were identified and separated into cohorts. Patients who underwent surgery in July were identified in both cohorts. Patient demographics, comorbidities (CCI), length of stay (LOS), costs, and mortality were assessed. SPSS v.20 was utilized for statistical analysis with Student´s T-test for discrete variables and χ2-test for categorical data. A p-value of < 0.05 denoted significance.

Results: A total of 73,333 lumbar spine cases were identified in the NIS of which 39,187 (53.4%) were performed in teaching hospitals and 34,146 (46.6%) in non-teaching institutions. The July patients comprised of 8.1% and 7.7% of cases in the teaching and non-teaching hospital cohorts respectively. The July admits did not demonstrate significant demographic differences compared to the August-June patients. The July admits were significantly younger and demonstrated a greater comorbidity burden in the teaching hospital cohort compared to those in the non-teaching hospital cohort (p< 0.05). In addition, the LOS, total hospital costs, and mortality did not significantly vary depending upon the time of the academic year. But, the July admits demonstrated a greater LOS and total hospital costs in the teaching hospitals compared to those managed in non-teaching institutions (p< 0.05). In the teaching hospital cohort, the July admits demonstrated a greater incidence of urinary tract infections compared to the August-June patients (p< 0.05). In contrast, the non-teaching cohort did not demonstrate significant differences in the incidences of postoperative complications with regards to the academic timeline.

Conclusion: This national study did not demonstrate an increase in the LOS, total hospital costs, or mortality depending upon the time of the academic year regardless of the hospital teaching status. This finding may reduce concerns regarding the quality of care of lumbar spine surgery at the beginning of the academic year. Further studies are warranted to characterize the greater healthcare resource utilization demonstrated among the July admits in teaching hospitals.