Spine Journal - 2026-08-01 - Journal Article
The association between teaching hospital status and postoperative outcomes among adults undergoing long-segment posterior lumbar instrumentation.
Karnati J, Kaghazchi A, Ashraf A, Lunasco L, Jelkin G, Abid S, Wu A, Ranganathan S, Wallace M, Ashraf M, Cheng J, Adogwa O
Topics
Key Takeaway
Nonacademic centers had 31% higher odds of pseudoarthrosis or mechanical failure at 1 year (OR=1.314) and more than double the 30-day readmission rate (OR=2.211) compared to academic centers after long-segment posterior lumbar fusion.
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Summary
This study used the TriNetX database to compare outcomes of long-segment (3–12 level) posterior lumbar instrumentation at academic vs. nonacademic centers in 39,582 patients from 2010–2022, with propensity score matching for demographics and comorbidities. Short-term surgical and medical complication rates were equivalent between settings at 30 and 90 days. Nonacademic centers showed significantly higher pseudoarthrosis/mechanical failure at 1 year (OR=1.314) and 2 years (OR=1.265), and markedly higher readmission at 30 days (OR=2.211) and 90 days (OR=1.920).
Key Limitation
The database lacks radiographic, implant-level, and surgeon volume data, so the mechanism driving higher pseudoarthrosis and readmission at nonacademic centers—whether technique, bone graft choice, postoperative protocol, or residual case-mix confounding—cannot be determined.
Original Abstract
BACKGROUND CONTEXT
Long-segment lumbar spine fusions (LSLF) are widely performed in the United States to address degenerative conditions, instability, and deformities but carry substantial risks of surgical and medical complications. With demand expected to rise alongside an aging population, understanding factors that influence outcomes is critical. Hospital teaching status may play a role, as academic centers offer multidisciplinary resources and trainee involvement, whereas nonacademic hospitals may prioritize efficiency and patient flow. Prior studies across surgical disciplines, including spine surgery, have reported inconsistent findings, and few have comprehensively examined complication profiles after LSLF. This study evaluates the association between hospital teaching status and surgical, mechanical, and medical complications following LSLF, with readmission risk assessed as an exploratory outcome.
PURPOSE
To evaluate the association between hospital teaching status and short- and long-term outcomes following long-segment posterior lumbar spine procedures.
STUDY DESIGN
Retrospective study utilizing the TriNetX Research Network.
PATIENT SAMPLE
Patients who underwent posterior lumbar instrumentation spanning 3 to 12 vertebral segments for lumbar spinal stenosis, spondylolisthesis, or scoliosis.
OUTCOME MEASURES
Primary outcomes included surgical complications (wound dehiscence, infection, reoperation) at 30 and 90 days postoperatively. Secondary outcomes assessed medical complications at 30 and 90 days, and pseudoarthrosis or mechanical failure at 1 and 2 years postoperatively. Exploratory outcomes were readmission rates at 30 and 90 days.
METHODS
The TriNetX Research Network was queried from January 1, 2010, to December 31, 2022. Patients were categorized by academic or nonacademic treatment centers. Propensity score matching was used to control for age, gender, race, and comorbidities.
RESULTS
Initially, 39,582 patients (8,506 nonacademic, 31,076 academic) met criteria. Following 1:1 propensity score matching, each cohort consisted of 6,548 patients. No significant difference in surgical complication rates between academic and nonacademic centers was observed at 30 days (OR=0.950, 95% CI [0.823-1.097]) or 90 days (OR=0.971, 95% CI [0.866-1.089]). Medical complication rates were similar at 30 days (OR=1.022, 95% CI [0.897-1.165]) and 90 days (OR=1.015, 95% CI [0.907-1.136]). At 1 year, patients at nonacademic centers exhibited significantly higher odds of pseudoarthrosis or mechanical failure (OR=1.314, 95% CI [1.213-1.423]), which persisted at 2 years postoperatively (OR=1.265, 95% CI [1.171-1.367]). Exploratory analyses revealed significantly higher odds of readmission at both 30 days (OR=2.211, 95% CI [2.044-2.390]) and 90 days (OR=1.920, 95% CI [1.781-2.066]) for patients at nonacademic centers.
CONCLUSIONS
In this large-scale, propensity-matched retrospective analysis, nonacademic centers demonstrated comparable short-term medical complication rates and surgical, but higher long-term risks of pseudoarthrosis or mechanical failure, and substantially increased readmission rates compared to academic centers. These findings highlight the influence of hospital teaching status on long-segment lumbar spine procedure outcomes and emphasize the need for improved perioperative management across different hospital settings.