The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury

Rafael De la Garza Ramos, Jonathan Nakhla, Rani Nasser, Ajit Jada, Daniel M. Sciubba, Merritt D. Kinon, Reza Yassari

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI). Methods Data from the Nationwide Inpatient Sample (2002–2011) were reviewed. Patients were included if they had a diagnosis of closed vertebral column fracture with SCI, underwent spine surgery, and were admitted urgently or emergently. Early intervention (the day of or the day after admission), inpatient morbidity and mortality rates were compared between patients admitted to teaching versus nonteaching hospitals. Multivariable regression analyses were performed. Results A total of 9236 patients were identified (mean age 43 years, 82.6% male gender), with 78.7% admitted to a teaching hospital (n = 7,272) and 21.3% to a nonteaching hospital (n = 1,964). The most common mechanism of injury was a motor vehicle collision (43.9%), while the most common fracture location was between C5 and C7 (35.3%), and 22% of cases were complete SCIs. Following multivariable analysis, teaching hospital status was significantly associated with early intervention (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01–1.25), but not with complication development (OR, 1.09; 95% CI, 0.98–1.23) or mortality (OR, 1.19; 95% CI, 0.91–1.56). Conclusions In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching hospitals versus nonteaching hospitals for patients with SCI are encouraged.

Original languageEnglish (US)
Pages (from-to)140-144
Number of pages5
JournalWorld Neurosurgery
Volume99
DOIs
StatePublished - Mar 1 2017

Fingerprint

Spinal Cord Injuries
Teaching Hospitals
Inpatients
Spine
Morbidity
Mortality
Odds Ratio
Confidence Intervals
Motor Vehicles
Teaching
Regression Analysis
Wounds and Injuries

Keywords

  • Nationwide Inpatient Sample
  • Spinal cord injury
  • Surgery
  • Teaching hospitals
  • Timing

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury. / De la Garza Ramos, Rafael; Nakhla, Jonathan; Nasser, Rani; Jada, Ajit; Sciubba, Daniel M.; Kinon, Merritt D.; Yassari, Reza.

In: World Neurosurgery, Vol. 99, 01.03.2017, p. 140-144.

Research output: Contribution to journalArticle

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abstract = "Objective To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI). Methods Data from the Nationwide Inpatient Sample (2002–2011) were reviewed. Patients were included if they had a diagnosis of closed vertebral column fracture with SCI, underwent spine surgery, and were admitted urgently or emergently. Early intervention (the day of or the day after admission), inpatient morbidity and mortality rates were compared between patients admitted to teaching versus nonteaching hospitals. Multivariable regression analyses were performed. Results A total of 9236 patients were identified (mean age 43 years, 82.6{\%} male gender), with 78.7{\%} admitted to a teaching hospital (n = 7,272) and 21.3{\%} to a nonteaching hospital (n = 1,964). The most common mechanism of injury was a motor vehicle collision (43.9{\%}), while the most common fracture location was between C5 and C7 (35.3{\%}), and 22{\%} of cases were complete SCIs. Following multivariable analysis, teaching hospital status was significantly associated with early intervention (odds ratio [OR], 1.12; 95{\%} confidence interval [CI], 1.01–1.25), but not with complication development (OR, 1.09; 95{\%} CI, 0.98–1.23) or mortality (OR, 1.19; 95{\%} CI, 0.91–1.56). Conclusions In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching hospitals versus nonteaching hospitals for patients with SCI are encouraged.",
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AB - Objective To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI). Methods Data from the Nationwide Inpatient Sample (2002–2011) were reviewed. Patients were included if they had a diagnosis of closed vertebral column fracture with SCI, underwent spine surgery, and were admitted urgently or emergently. Early intervention (the day of or the day after admission), inpatient morbidity and mortality rates were compared between patients admitted to teaching versus nonteaching hospitals. Multivariable regression analyses were performed. Results A total of 9236 patients were identified (mean age 43 years, 82.6% male gender), with 78.7% admitted to a teaching hospital (n = 7,272) and 21.3% to a nonteaching hospital (n = 1,964). The most common mechanism of injury was a motor vehicle collision (43.9%), while the most common fracture location was between C5 and C7 (35.3%), and 22% of cases were complete SCIs. Following multivariable analysis, teaching hospital status was significantly associated with early intervention (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01–1.25), but not with complication development (OR, 1.09; 95% CI, 0.98–1.23) or mortality (OR, 1.19; 95% CI, 0.91–1.56). Conclusions In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching hospitals versus nonteaching hospitals for patients with SCI are encouraged.

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