Konda Sanjit R, Lott Ariana, Manoli Arthur, Patel Karan, Egol Kenneth A
*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY; and †Division of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY.
J Orthop Trauma. 2017 Nov;31(11):e364-e368. doi: 10.1097/BOT.0000000000000927.
To compare the cost and outcomes of patients treated at orthopaedic teaching hospitals (OTHs) with those treated at nonteaching hospitals (NTHs).
Retrospective study.
The Statewide Planning and Research Cooperative Systems (SPARCS) database, which includes all admissions to New York State hospitals from 2000-2011.
PATIENTS/PARTICIPANTS: A total of 165,679 patients with isolated closed hip fracture 65 years of age and older met inclusion criteria. Of them, 57,279 were treated at OTH and 108,400 were treated at NTH.
Admission for the management of a hip fracture.
Cost, length of stay (LOS), and inpatient mortality.
Univariate analysis shows that mean total hospital costs were higher at OTH ($16,576 ± $17,514) versus NTH ($13,358 ± $11,366) (P < 0.001); LOS was equivalent at OTH (8.0 ± 9.0 days) versus NTH (8.0 ± 7.6 days) (P = 0.904); and mortality was lower in OTH (3.4%) versus NTH (4.0%) (P < 0.001). In the multivariate total cost analysis, in addition to demographic differences, we identified total hospital beds and total ICU beds as significant confounding variables. Interestingly, when controlling for these patient and hospital factors, OTH designation was not a significant predictor of cost. In addition, multivariate analysis found that OTH status decreased LOS by 0.743 days (95% confidence interval: 0.632-0.854, P < 0.001) and mortality by 21% (odds ratio 0.794, 95% confidence interval: 0.733-0.859, P < 0.001), confirming the univariate trends.
While OTH may seem to have higher hospital costs for operative hip fractures on cursory analysis, controlling for patient and hospital factors including hospital bed number negates this effect such that OTH has no additional cost compared with NTH. In addition, OTH status is associated with shorter LOS and lower in-hospital mortality. With the results of this study, health care systems and patients should feel confident that the quality of care at teaching hospitals is no less and potentially better than that at NTH with no added cost.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较在骨科教学医院（OTHs）接受治疗的患者与在非教学医院（NTHs）接受治疗的患者的费用和治疗结果。
回顾性研究。
全州规划与研究合作系统（SPARCS）数据库，其中包括2000年至2011年纽约州所有医院的入院病例。
患者/参与者：共有165,679例65岁及以上的单纯闭合性髋部骨折患者符合纳入标准。其中，57,279例在OTHs接受治疗，108,400例在NTHs接受治疗。
因髋部骨折入院治疗。
费用、住院时间（LOS）和住院死亡率。
单因素分析显示，OTHs的平均总住院费用（16,576美元±17,514美元）高于NTHs（13,358美元±11,366美元）（P<0.001）；OTHs的住院时间（8.0±9.0天）与NTHs（8.0±7.6天）相当（P = 0.904）；OTHs的死亡率（3.4%）低于NTHs（4.0%）（P<0.001）。在多因素总费用分析中，除了人口统计学差异外，我们确定医院总床位数和重症监护病房总床位数为显著的混杂变量。有趣的是，在控制了这些患者和医院因素后，OTH的指定并不是费用的显著预测因素。此外，多因素分析发现，OTH状态使住院时间缩短0.743天（95%置信区间：0.632 - 0.854，P<0.001），死亡率降低21%（优势比0.794，95%置信区间：0.733 - 0.859，P<0.001），证实了单因素分析的趋势。
虽然初步分析可能显示OTHs治疗髋部骨折的住院费用较高，但控制包括病床数量在内的患者和医院因素可消除这种影响，因此OTHs与NTHs相比没有额外费用。此外，OTH状态与较短的住院时间和较低的住院死亡率相关。基于本研究结果，医疗保健系统和患者应确信教学医院的医疗质量不低于且可能优于NTHs，且没有额外费用。
预后水平III。有关证据水平的完整描述，请参阅作者指南。
