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Complications After Lumbar Spine Surgery Between Teaching and Nonteaching Hospitals

Nandyala, Sreeharsha V. BA; Marquez-Lara, Alejandro MD; Fineberg, Steven J. MD; Hassanzadeh, Hamid MD; Singh, Kern MD

doi: 10.1097/BRS.0000000000000149
Health Services Research

Study Design. Retrospective national database analysis.

Objective. A national population-based database was analyzed to characterize the perioperative complications of lumbar spine procedures performed at teaching and nonteaching hospitals.

Summary of Background Data. Perception biases exist regarding the complications of lumbar spine surgery based upon the hospital teaching environment.

Methods. Data from the Nationwide Inpatient Sample was queried from 2002–2011. Patients undergoing an anterior lumbar interbody fusion, posterior lumbar interbody fusion, anterior/posterior lumbar fusion, or lumbar decompression to treat lumbar degenerative pathology were identified and separated into cohorts based upon the teaching status of the hospital. Patient demographics, Charlson Comorbidity Index, length of stay, complications, mortality, and costs were assessed.

Results. A total of 658,616 lumbar procedures were identified from 2002–2011, of which 367,875 (55.9%) were performed at teaching hospitals. An older patient population comprised the teaching hospital cohort and demonstrated a greater comorbidity burden than the nonteaching group (Charlson Comorbidity Index 2.90 vs. 2.55; P < 0.001). In addition, the teaching hospital cohort was associated with a significantly greater number of multilevel fusion cases (P < 0.001) and incurred a greater mean length of stay (3.7 vs. 3.0 d; P < 0.001). Patients treated at teaching hospitals demonstrated a significantly greater incidence of postoperative pulmonary embolism, deep vein thrombosis, infection, and neurological complications than the nonteaching cohort (P < 0.001). Overall, there were no significant differences in the mean total hospital costs or mortality between the hospital cohorts. Regression analysis demonstrated that teaching status was not a significant predictor of mortality (OR, 1.02; confidence interval 0.8–1.2; P = 0.8).

Conclusion. Patients treated in teaching hospitals for lumbar spine surgery incurred a longer hospitalization and a greater incidence of postoperative complications including pulmonary embolism, deep vein thrombosis, infection, and neurological events. These findings may be explained by an increased complexity of procedures performed at teaching hospitals along with an older and a more comorbid patient population. Despite these differences, the teaching status was not a significant predictor of in-hospital mortality after a lumbar spine surgery.

Level of Evidence: 3

A national database analysis of lumbar spine surgery demonstrated that patients managed at academic centers were associated with a greater case complexity, an increased hospitalization, and greater complication rates than those managed in private hospitals. There were no significant differences in the costs or mortality based upon the hospital teaching status.

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612; E-mail:

Acknowledgment date: September 4, 2013. First revision date: October 21, 2013. Second revision date: November 18, 2013. Acceptance date: November 22, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties.

© 2014 by Lippincott Williams & Wilkins