Impact of Hospital Teaching Status on Mortality, Length of Stay and Cost Among Patients With Cardiac Arrest in the United States

• Published in: The American journal of cardiology Vol. 118; no. 5; pp. 668 - 672
• Main Authors: Dolmatova, Elena V., MD, Moazzami, Kasra, MD, MPH, Klapholz, Marc, MD, Kothari, Neil, MD, Feurdean, Mirela, MD, Waller, Alfonso H., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Cardiovascular; Coma; Comorbidity; Demographics; Female; Health Care Costs - statistics & numerical data; Heart Arrest - economics; Heart Arrest - mortality; Hospital Mortality; Hospitals - statistics & numerical data; Hospitals, Teaching - economics; Hospitals, Teaching - statistics & numerical data; Humans; Hyperglycemia; Inpatients - statistics & numerical data; Intervention; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Middle Aged; Morbidity; Mortality; Multivariate analysis; Ostomy; Patients; Pneumonia; Retrospective Studies; Studies; Teaching hospitals; United States - epidemiology; Urban areas; United States > US
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.05.062

Limited data exist regarding the in-hospital outcomes in patients with cardiac arrest (CA) in teaching versus nonteaching hospital settings. Using the Nationwide (National) Inpatient Sample (2008 to 2012), 731,107 cases of CA were identified using International Classification of Diseases, Ninth Edition codes. Among these patients, 348,368 (47.6%) were managed in teaching hospitals and 376,035 (51.4%) in nonteaching hospitals. Patients in teaching hospitals with CA were younger (62.42 vs 68.08 years old), had less co-morbidities (p <0.001), were less likely to be white (54.6% vs 65.5%) and more likely to be uninsured (9.1% vs 7.6%). Mortality in patients with CA was significantly lower in teaching hospitals than in nonteaching hospitals (55.3% vs 58.8%; all p <0.001). The mortality remained significantly lower after adjusting for baseline patient and hospital characteristics (odds ratio 0.917, CI 0.899 to 0.937, p <0.001). However, the survival benefit was no longer present after adjusting for in-hospital procedures (OR 0.997, CI 0.974 to 1.02, p = 0.779). In conclusion, teaching status of the hospital was associated with decreased in-hospital mortality in patients with CA. The differences in mortality disappeared after adjusting for in-hospital procedures, indicating that routine application of novel therapeutic methods in patients with CA in teaching hospitals could translate into improved survival outcomes.