De la Garza-Ramos Rafael, Jain Amit, Kebaish Khaled M, Bydon Ali, Passias Peter G, Sciubba Daniel M
Departments of 1 Neurosurgery and.
Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
J Neurosurg Spine. 2016 Jul;25(1):15-20. doi: 10.3171/2015.11.SPINE151021. Epub 2016 Mar 4.
OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82-0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.
目的 本研究旨在比较美国教学医院与非教学医院成人脊柱畸形（ASD）手术后的住院患者发病率和死亡率。方法 利用全国住院患者样本确定2002年至2011年间接受ASD手术的患者。仅纳入年龄大于21岁的患者和择期病例。比较教学医院和非教学医院的患者特征、住院患者发病率和住院患者死亡率。进行多变量逻辑回归分析以检验医院教学状况对手术结果的影响。结果 共确定7603例患者，其中教学医院组占61.2%（n = 4650），非教学医院组占38.8%（n = 2953）。两组间接受翻修手术的患者比例存在显著差异（教学医院为5.2%，非教学医院为3.9%，p = 0.008）。同样，复杂手术（定义为融合8个或更多节段和/或截骨术）在教学医院更为常见（27.3%对21.7%，p < 0.001）。教学医院的总体粗并发症发生率（47.9%）与非教学医院（49.8%，p = 0.114）相似。在控制患者特征、病例复杂性和翻修状况后，与在非教学医院接受治疗的患者相比，在教学医院接受治疗的患者发生并发症的可能性显著降低（OR 0.89；95% CI 0.82 - 0.98）。教学医院的死亡率为0.4%，非教学医院的死亡率< 0.4%（p = 0.210）。结论 与在非教学医院接受治疗的患者相比，在教学医院接受ASD手术的患者发生并发症的几率可能显著更低。
