Does Hospital Teaching Status Affect the Outcomes of Patients Undergoing Anterior Cervical Discectomy and Fusion?
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Background: Teaching hospitals are responsible for the training and education of residents and have been centers of research and advancement in an era of evidence-based medicine. Several studies have reported conflicting findings regarding the effects of teaching status on the outcomes of patients. In the present study, we aimed to identify the differences in surgical outcomes among patients who had undergone anterior cervical discectomy and fusion (ACDF) between teaching and nonteaching hospitals. Methods: We queried the National Inpatient Sample for 2012e2015. We identified patients with cervical degenerative disease who had undergone single-level ACDF using the International Classification of Disease, 9th revision, diagnosis and procedure codes. One-to-one propensity score matching was conducted, using appropriate and clinically relevant variables. Stepwise multivariable logistic regression was performed to assess the effect of teaching status on the outcomes of interest. Finally, a marginal effect analysis was conducted to compare the differences in admission costs stratified by teaching status within each insurance type. Results: A total of 52,212 patients who had undergone elective ACDF from 2012 to 2015 were identified and matched, with 26,106 patients in each group. On multivariable regression, after adjusting for demographics and hospital characteristics, teaching hospitals were associated with greater odds of nonroutine discharge (odds ratio, 1.25; P < 0.001) and higher admission cost (coefficient, 414.31; P [ 0.002). However, teaching status was not associated with inpatient mortality or morbidity. The marginal effect analysis results indicated that privately insured patients incurred greater costs in nonteaching hospitals. Conclusion: Our results have shown that patients undergoing ACDF at nonteaching hospitals had a greater odds of routine discharge and higher admission costs compared with those at teaching hospitals but similar outcomes in terms of inpatient mortality and morbidity.