Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Spine (Phila Pa 1976). 2013 Jun 1;38(13):1089-96. doi: 10.1097/BRS.0b013e31828da26d.
Retrospective national database analysis.
A national population-based database was analyzed to characterize cervical spine procedures performed at teaching and nonteaching hospitals with regards to patient demographics, clinical outcomes/complications, resource use, and costs.
There are mixed reports in the literature regarding the quality and costs of health care provided by teaching hospitals in the United States. However, outcomes of cervical spine surgery based upon teaching status remains largely unknown. METHODS.: Data from the Nationwide Inpatient Sample were obtained from 2002-2009. Patients undergoing elective anterior or posterior cervical fusion, or posterior cervical decompression (i.e., laminoforaminotomy, laminectomy, laminoplasty) for a diagnosis of cervical myelopathy and/or radiculopathy were identified and separated into 2 cohorts (teaching and nonteaching hospitals). Patient demographics, comorbidities, complications, length of hospitalization, costs, and mortality were compared for both groups. Regression analysis was performed to assess independent predictors of mortality.
A total of 212,385 cervical procedures were identified from 2002-2009 in the United States, with 54.6% performed at teaching hospitals. More multilevel fusions and posterior approaches were performed in teaching hospitals (P < 0.0005). Patients treated in teaching hospitals trended toward male sex, increased costs, and hospitalizations. Overall, procedure-related complications and inhospital mortality were increased in teaching hospitals. Regression analysis revealed that significant predictors of mortality were age 65 years or more (odds ratio = 3.0) and multiple comorbidities. Teaching status was not a significant predictor of mortality (P = 0.07).
Patients treated in teaching hospitals for cervical spine surgery demonstrated longer hospitalizations, increased costs, and mortality compared with patients treated in nonteaching hospitals. Incidences of postoperative complications were identified to be higher in teaching hospitals. Possible explanations for these findings are an increased complexity of procedures performed at teaching hospitals. Older age and presence of comorbidities were more significant predictors of inhospital mortality than teaching status. Future studies should identify long-term complications and costs beyond an inpatient setting to assess if differences extend beyond the perioperative period.
回顾性全国数据库分析。
对全国人群数据库进行分析，以了解在教学医院和非教学医院进行颈椎手术的患者人口统计学特征、临床结果/并发症、资源利用和成本。
美国教学医院提供的医疗质量和成本存在混合报告。然而，基于教学状态的颈椎手术结果在很大程度上仍然未知。
从 2002 年至 2009 年，从全国住院患者样本中获取数据。对诊断为颈椎病和/或神经根病的患者进行选择性前路或后路颈椎融合术，或后路颈椎减压术（即椎板切开术、椎板切除术、椎板成形术），并将其分为 2 组（教学医院和非教学医院）。比较两组患者的人口统计学特征、合并症、并发症、住院时间、费用和死亡率。进行回归分析以评估死亡率的独立预测因素。
2002 年至 2009 年期间，美国共进行了 212385 例颈椎手术，其中 54.6%在教学医院进行。教学医院进行的多节段融合和后路入路更多（P<0.0005）。教学医院的患者更倾向于男性，费用和住院时间增加。总体而言，教学医院的手术相关并发症和住院期间死亡率增加。回归分析显示，年龄 65 岁或以上（优势比=3.0）和多种合并症是死亡率的显著预测因素。教学状态不是死亡率的显著预测因素（P=0.07）。
与在非教学医院接受颈椎手术治疗的患者相比，在教学医院接受颈椎手术治疗的患者住院时间更长、费用更高、死亡率更高。教学医院术后并发症发生率较高。造成这些发现的可能原因是教学医院进行的手术复杂性增加。年龄较大和存在合并症比教学状态更能预测住院期间的死亡率。未来的研究应确定住院治疗以外的长期并发症和成本，以评估这些差异是否超出围手术期。
4 级
