Does the Teaching Status of the Hospital have an Impact on Outcomes Among Patients undergoing Anterior Cervical Discectomy and Fusion

ABSTRACT BACKGROUND Teaching hospitals are responsible for the training and education of residents and are a hub of research and advancement in an era of evidence-based medicine. Several studies have reported conflicting findings regarding the impact of teaching status on outcomes of patients. In this study, we aim to identify the differences in surgical outcomes among patients undergoing anterior cervical discectomy and fusion(ACDF) between teaching and non-teaching hospitals. METHODS We queried the National Inpatient Sample(NIS) for the years 2012-2015. We identified patients with cervical degenerative-disease undergoing single-level ACDF using ICD-9 diagnosis and procedure-codes. One-to-one propensity-score matching was conducted, using appropriate and clinically relevant variables. Stepwise-multivariable logistic regression was conducted to assess the effect of teaching status on outcomes of interest. Marginal-effect analysis was conducted to compare difference in admissions cost between teaching statuses within each insurance type. RESULT A total of 52,212 patients undergoing elective ACDF between 2012 and 2015 were identified and matched, 26,106 patients in each teaching status. On multivariable regression, after adjusting for demographics and hospital characteristics, teaching hospitals were associated with higher odds of non-routine discharge(OR:1.25;p CONCLUSION According to our results, patients undergoing ACDF at non-teaching hospitals were associated with higher odds of routine discharges and admissions cost compared to those at teaching hospitals, but similar outcomes in terms of inpatient mortality and inpatient morbidity.