Differences in outcomes of cervical spine surgery at teaching versus non-teaching hospitals

Teaching hospitals have higher mortality and complication rates—but also do higher-risk procedures, reports study in Spine

2013-06-12

(Press-News.org) Philadelphia, Pa. (June 12, 2013) - For patients undergoing surgery on the cervical (upper) spine, overall rates of complications and death are higher at teaching hospitals than at non-teaching hospitals, reports a study in the June 1 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

But the differences are small and are likely explained by the more-complex surgeries performed and higher-risk patients treated at teaching hospitals, according to the report by Dr Kern Singh of Rush University Medical Center, Chicago, colleagues.

Small Increase in Risks with Cervical Spine Surgery at Teaching Hospitals… Using a national database (the Nationwide Inpatient Sample), the researchers identified more than 212,000 cervical spine surgeries performed at U.S. hospitals between 2002 and 2009. The study focused on cervical fusion procedures, performed to join together one or more vertebrae in the upper spine; and various decompression procedures, done to relieve pressure on spinal nerves.

Dr Singh and colleagues compared complication and mortality rates for patients treated at teaching hospitals, which have residency training programs, versus non-teaching hospitals. The characteristics of the patients treated and procedures performed were compared as well. About 55 percent of the procedures were done at teaching hospitals, even though teaching hospitals accounted for just 30 percent of hospitals in the database.

Risks of both death and complications were higher at teaching hospitals. The mortality rate was twice as high: 1.2 per 1,000 patients at teaching hospitals, compared to 0.6 per 1,000 at non-teaching hospitals. The complication rate was also somewhat higher at teaching hospitals: 24.7 versus 17.4 per 1,000 patients.

…But Mainly Related to Higher-Risk Patients and Procedures However, there were also some significant differences in the types of surgeries performed and the characteristics of patients treated. Teaching hospitals performed more complex procedures, entailing higher surgical risks. For example, they performed more multilevel fusion procedures, in which three or more vertebrae are fused. Teaching hospitals also treated more patients with pre-existing medical conditions that could increase the risk of poor outcomes.

After adjustment for these and other factors, undergoing surgery at a teaching hospital was no longer associated with a higher mortality risk. In contrast, older age and certain medical conditions remained significant risk factors.

There's a long history of debate over the quality of care provided at teaching and nonteaching hospitals. Studies have found that teaching hospitals achieve better outcomes for patients with some common medical conditions, and for certain types of complex surgery. But patients are sometimes concerned about risks related to having a resident (trainee) surgeon perform their procedure.

The new study shows some "subtle yet significant" differences in outcomes of cervical spine surgery among U.S. teaching versus non-teaching hospitals. Mortality and complication rates appear higher at teaching hospitals. However, teaching hospitals also perform more complex surgeries in a higher-risk patient population, which likely explains the difference in outcomes.

Dr Singh and colleagues note some important limitations of their database analysis—for example, it provided no information on whether patients were operated on by a resident or not.

"This study should provide reassurance to patients that the presence of a teaching hospital will have little, if any, effect on their surgical outcomes," according to an editorial by Dr Timothy S. Carey of University of North Carolina. Further studies are needed to assess longer-term benefits or risks from cervical spine surgery, after patients are discharged from the hospital.

### Read the Full Article in Spine.

About Spine Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

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Differences in outcomes of cervical spine surgery at teaching versus non-teaching hospitals

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