The Impact of Teaching Hospital Status on Postoperative Outcomes among Adults Undergoing Short Segment Lumbar Instrumentation.

Abstract

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate the impact of teaching hospital status on short- and long-term surgical outcomes following single-level lumbar instrumentation. SUMMARY OF BACKGROUND DATA: Teaching hospital status and its effect on surgical outcomes have produced conflicting results, and, in spine surgery, have largely focused on perioperative complications and length of stay. More comprehensive analysis on long-term outcomes has yet to be consistently demonstrated. METHODS: The TriNetX Research Network was queried for adult patients who underwent short-segment lumbar fusion between 2010 and 2022 with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis, radiculopathy, or scoliosis. Patients were categorized based on treatment at academic or non-academic centers. Propensity score matching was employed to control for confounders. RESULTS: A total of 38,898 patients met the inclusion criteria, with 8,789 patients treated at non-academic centers and 30,109 at academic centers. After propensity score matching, cohorts included 7,004 patients each with comparable baseline characteristics. Surgical complications and medical complications showed no significant differences at 30 days (OR=1.120, 95% CI [0.971-1.292]; OR=0.927, 95% CI [0.785-1.095]) or 90 days (OR=1.072, 95% CI [0.949-1.211]; OR=0.988, 95% CI [0.859-1.135]). Non-academic centers had significantly higher odds of pseudoarthrosis or mechanical failure at one year (OR=1.819, 95% CI [1.675-1.975]) and two years (OR=1.732, 95% CI [1.599-1.875]). Additionally, readmission rates were significantly higher for non-academic center patients at both 30 days (OR=1.500, 95% CI [1.377-1.633]) and 90 days (OR=1.290, 95% CI [1.191-1.395]). CONCLUSION: This retrospective analysis using propensity score matching demonstrates that patients undergoing single-level lumbar instrumentation at non-academic hospitals have substantially higher odds of readmission and long-term mechanical failures compared to those treated at academic centers despite having similar rates of short term medical and surgical complications. These findings highlight the influence of hospital teaching status on postoperative outcomes, potentially informing clinical decisions, referrals, and institutional quality improvement initiatives. LEVEL OF EVIDENCE: 3.