Abstract Body:
Background: Hypertensive Emergencies (HE) are acute, life-threatening conditions requiring timely and effective management. While teaching hospitals often serve as centers of excellence, their impact on outcomes in HE remains unclear.
Objective: To evaluate the influence of teaching hospital status on mortality, complications, and resource utilization in patients hospitalized for hypertensive emergencies in the United States from 2016 to 2021.
Methods: This retrospective cohort study used data from 730,249 hospitalizations for HE between 2016 and 2021, comparing patient and hospital characteristics, in-hospital mortality, complications, charges, costs, and length of stay at teaching hospitals (n=530,185) vs. non-teaching Hospitals (n=200,064). We used multivariable logistic and linear regression models and adjusted for demographic, clinical, socioeconomic, and hospital-level factors.
Results: Patients admitted to teaching hospitals were younger (mean 57.3 vs. 59.7 years) and more likely to have Medicaid insurance (52.4% vs. 49.8%), whereas non-teaching hospitals saw relatively more privately insured (19.3% vs. 14.3%) and uninsured patients (9.5% vs. 6.6%). Teaching hospitals received more transfers (6.3% vs. 4.8%) and were predominantly large-bed facilities (44.2% vs. 14.2%). Unadjusted in-hospital mortality was higher at teaching hospitals (OR 1.18; 95% CI, 0.94–1.49), but not statistically significant. Adjusted analysis confirmed no significant mortality difference (AOR 1.13; 95% CI, 0.88–1.46; p=0.34). However, Teaching Hospitals were associated with higher odds of complications: acute stroke (AOR 1.10), acute kidney injury (1.11), pulmonary edema (1.30), retinal hemorrhage (2.41), aortic dissection (2.02), and heart failure (1.18) (all p<0.01). Teaching hospitals also demonstrated greater adjusted resource utilization, including higher total charges ($2,497), costs ($712), and length of stay (0.29 days), despite minimal clinical significance in length of stay.
Conclusions: While mortality in hypertensive emergencies did not differ significantly between hospital types, admission to teaching hospitals was associated with higher healthcare expenditures and greater rates of in-hospital complications. These findings highlight the need for targeted quality improvement initiatives and resource management strategies within teaching hospitals to optimize care efficiency and reduce complications.