89. Is academic department teaching status associated with adverse outcomes after lumbar fusion for degenerative spine diseases?

Abstract

BACKGROUND CONTEXT While teaching hospitals are necessary to facilitate resident maturation, concerns have been raised about the quality of care and potential inefficiencies. In the setting of increasing health care costs and an increasing rate of elective lumbar fusions, it is imperative that stakeholders involved in formulating payment models incentivizing cost efficiency understand outcomes associated with teaching status. PURPOSE There is currently limited data on how hospital teaching status affects short term economic and clinical outcomes in patients undergoing lumbar fusion for degenerative spine diseases. In this study, we compared the following outcomes according to academic status: (1) length of stay; (2) costs; (3) 30-day and 90-day readmission; (4) 30-day, 90-day and 1-year return to the operating room after lumbar fusion. STUDY DESIGN/SETTING Level III: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System database. PATIENT SAMPLE We identified 50,882 patients in the New York Statewide Planning and Research Cooperative System who underwent elective primary lumbar fusion in New York State between January 1, 2009 and September 30th, 2014. OUTCOME MEASURES We compared how academic teaching status affects: length and cost of the index admission; 30- and 90-day all cause readmission; and, 30-day, 90-day and 1-year return to the operating room after elective lumbar fusion for degenerative spine disease. METHODS We used the New York Statewide Planning and Research Cooperative System (SPARCS) to identify inpatients in New York State who underwent elective lumbar fusion between January 1, 2009 and September 30th, 2014. Patients with diagnoses of trauma, malignancy, inflammatory disease or infection were excluded. International Classification of Diseases, Ninth revision codes were utilized to extract diagnostic and procedural codes pertaining to lumbar fusion, patient demographics and outcomes of interest. SAS version 9.4 was used to conduct statistics. A unique patient identifier allowed for longitudinal follow-up. Linear and logistic regression models compared teaching and nonteaching hospitals after adjusting for patient demographics and comorbidities. RESULTS Patients undergoing surgery at teaching hospitals had 10% longer lengths of stay (4.2 vs 3.8 days, p CONCLUSIONS Elective lumbar fusion for degenerative lumbar conditions at teaching hospitals is associated with higher costs, increased length of stay and increased readmission rates at 30- and 90-days postoperatively. However, teaching hospitals may provide a protective effect in terms of reducing return to the OR, with a decreased risk for return to the operating room at 30-days, 90-days and 1-year postoperatively. These findings suggest that teaching hospitals may be adversely affected by reimbursement tied to competition on economic and clinical metrics. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.