Mastrokostas Paul G, Mastrokostas Leonidas E, Dayan Jason M, Schwartz Luke B, Razi Joseph, Emara Ahmed K, Saleh Ahmed, Monsef Jad Bou, Razi Afshin E, Ng Mitchell K
Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA.
J Orthop. 2025 Jun 1;69:150-154. doi: 10.1016/j.jor.2025.05.066. eCollection 2025 Nov.
Hospital size has been shown to influence resource availability, staffing, and patient care quality. This study aims to evaluate the impact of hospital size on postoperative outcomes such as length of stay (LOS), total costs, complications, and non-routine discharge rates in patients undergoing single-level CDA.
The National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients who underwent single-level CDA between 2016 and 2020. Patients undergoing single-level CDA were stratified by hospital size (small, medium, large). Chi-square and ANOVA tests were used to compare demographic variables and outcomes across hospital sizes. Ridge regression was employed to analyze the relationship between perioperative complications and non-routine discharge across hospital sizes. Statistical significance was set at the 0.05 level.
Patients treated in smaller hospitals were younger than those in medium and large hospitals (46.9 vs. 48.4 and 48.0 years, = 0.036). LOS was shorter in small hospitals compared to medium and large-sized hospitals (1.30 vs. 1.45 vs. 1.45 days, = 0.048). Medium hospitals had a higher rate of non-routine discharges (9.3 %) compared to small (5.3 %) and large hospitals (6.2 %, = 0.004). Cardiovascular complications were predictive of non-routine discharge in large hospitals (OR = 2.31, = 0.048), while surgical complications were significant in medium hospitals (OR = 2.00, = 0.010).
Medium hospitals demonstrated longer LOS and higher non-routine discharge rates, likely due to resource limitations. Enhancing staffing and care coordination may improve outcomes across hospital settings.
医院规模已被证明会影响资源可用性、人员配备和患者护理质量。本研究旨在评估医院规模对接受单节段颈椎间盘置换术（CDA）患者术后结局的影响，如住院时间（LOS）、总费用、并发症和非常规出院率。
查询国家住院患者样本（NIS），以确定2016年至2020年间接受单节段CDA的14315例加权病例。接受单节段CDA的患者按医院规模（小、中、大）分层。采用卡方检验和方差分析来比较不同医院规模的人口统计学变量和结局。采用岭回归分析不同医院规模围手术期并发症与非常规出院之间的关系。统计学显著性设定为0.05水平。
在小型医院接受治疗的患者比中型和大型医院的患者更年轻（46.9岁 vs. 48.4岁和48.0岁，P = 0.036）。与中型和大型医院相比，小型医院的住院时间更短（1.30天 vs. 1.45天 vs. 1.45天，P = 0.048）。中型医院的非常规出院率（9.3%）高于小型医院（5.3%）和大型医院（6.2%，P = 0.004）。心血管并发症是大型医院非常规出院的预测因素（OR = 2.31，P = 0.048），而手术并发症在中型医院具有显著性（OR = 2.00，P = 0.010）。
中型医院的住院时间更长，非常规出院率更高，可能是由于资源限制。加强人员配备和护理协调可能会改善所有医院环境中的结局。
