DIFFERENCE IN HEALTHCARE OUTCOMES BETWEEN TEACHING AND NON-TEACHING HOSPITALS FOR PATIENTS ADMITTED WITH CROHN'S DISEASE

Abstract

Abstract BACKGROUND The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Crohn’s disease (CD) is a costly disorder among hospitalized patients. Its complications often require endoscopic interventions, surgery, and advance levels of care, for which approaches are not standardized. METHODS We queried the National Inpatient Sample (NIS)[GS1] 2016-2019 using ICD10-PCS codes. Patients were subsequently divided based on the concomitant diagnosis of CD and subcategorized between teaching and non-teaching institutions. In-hospital mortality, total hospital cost, length of stay, and in-hospital complications were evaluated. Multivariate logistic regression analysis was conducted to adjust for confounders. RESULTS A total of 141,865 discharges with diagnosis of CD were identified, of which 108,735 (76.6%) were admitted to a teaching institution and 33,130 (23.4%) to a non-teaching institution. Those admitted to a teaching hospital were most likely to be black (10.0% vs 15.1%; P<0.01), Hispanic (4.4% vs 5.6%; P<0.01), have a Charlson score of ≥3 (27.1% vs 31.3%; P<0.01), belong to the highest income bracket (17.8% vs 24.7%; P<0.01), have private insurance (43.7% vs 51.3%; P<0.01), and be located in the northeastern U.S. (14.9% vs 23.8%; P<0.01). Those admitted to a teaching institution were more likely to have fistulizing disease (7.8% vs 15.6%; P<0.01), require parenteral nutrition (3.0% vs 6.1%; P<0.01), have severe malnutrition (4.8% vs 8.3%; P<0.01), undergo colonoscopy (10.4% vs 12.8%; P<0.01), and undergo bowel resection including large bowel (6.4% vs 11.4%; P<0.01) and small bowel (1.6% vs 2.4%; P<0.01), and were more likely to require conversion from laparoscopy to open laparotomy (0.8% vs 1.9%) during surgery. On multivariate analysis, there was no significant difference in mortality [aOR 0.84; (P=0.59)] between teaching and nonteaching institutions. However, we found worse outcomes within teaching institutions such as a prolonged mean length of stay (4.5 days vs 5.6 days; P<0.01), more likely to need surgical bowel resection including small [aOR 1.39; (P<0.01)] and large [aOR 1.66; (P<0.01)], to develop venous thromboembolism [aOR 1.97; (P<0.01)], and to require conversion to open surgery during laparoscopy [aOR 2.3; (P<0.01), and ileus (aOR 1.18; (P<0.01)], they were less likely to require endotracheal intubation [aOR 0.63; (P=0.02)]. CONCLUSIONS Institutional designs impact outcomes in CD, albeit no difference in mortality. In general, complication rates and resource utilization are higher in teaching centers when compared to non-teaching.