University hospital

A university hospital is an institution which combines the services of a hospital with the education of medical students and with medical research and training. These hospitals are typically affiliated with a medical school or university.

Today, neurosurgery is part of the portfolio of all university hospitals. It is a highly specialized service that, because of high costs, is often centralized.

In most cases, teaching hospitals also offer Graduate Medical Education (GME)/ physician residency programs, where medical school graduates train under a supervising (attending) physician to assist with the coordination of care.

In addition to offering medical education to medical students and physician residents, many teaching hospitals also serve as research institutes.

Although institutions for caring for the sick are known to have existed much earlier in history, the first teaching hospital, where students were authorized to methodically practice on patients under the supervision of physicians as part of their education, was reportedly the Academy of Gundishapur in the Persian Empire during the Sassanid era.

The interpretation of the results of prior studies on the association of hospital teaching status with surgical outcomes is limited by selection bias.

Using a comprehensive all-payer cohort of surgical patients in New York State, Bekelis et al., identified an association of treatment in teaching hospitals with increased case fatality, rate of discharge to rehabilitation, and longer LOS. Further research into the factors contributing to superior outcomes in nonteaching institutions is warranted ¹⁾.

To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI).

Data from the Nationwide Inpatient Sample (2002 - 2011) were reviewed. Patients were included if they had a diagnosis of closed vertebral column fracture with SCI, underwent spine surgery, and were admitted urgently or emergently. Early intervention (the day of or the day after admission), inpatient morbidity and mortality rates were compared between patients admitted to teaching versus nonteaching hospitals. Multivariable regression analyses were performed.

A total of 9,236 patients were identified (mean age 43 years, 82.6% male gender), with 78.7% admitted to a teaching hospital (n=7,272) and 21.3% to a nonteaching hospital (n=1,964). The most common mechanism of injury was a motor vehicle collision (43.9%), while the most common fracture location was between C5 and C7 (35.3%), and 22% of cases were complete SCIs. Following multivariable analysis, teaching hospital status was significantly associated with early intervention (OR 1.12; 95% CI, 1.01 - 1.25), but not with complication development (OR 1.09; 95% CI, 0.98 - 1.23) or mortality (OR 1.19; 95% CI, 0.91 - 1.56).

In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching versus nonteaching hospitals for patients with SCI are encouraged ²⁾.