Hospital teaching status and outcomes of complex surgical procedures in the United States.
OBJECTIVE
Complex operations performed in teaching hospitals have similar outcomes as those performed in nonteaching hospitals.


METHODS
Observational cohort study with clinical patient data obtained from the Nationwide Inpatient Sample. The Nationwide Inpatient Sample data were linked to the American Hospital Association hospital survey data for 1997 to determine hospital characteristics. Hospitals were considered high volume if they performed more than the median (50th percentile) number of procedures per year.


METHODS
Nationally representative sample of hospitals during 1996 and 1997.


METHODS
Individuals undergoing esophageal resection (n = 1247), hepatic resection (n = 2073), or pancreatic resection (n = 3337) in Nationwide Inpatient Sample hospitals during 1996 and 1997 were included.


METHODS
Unadjusted and adjusted in-hospital mortality and prolonged length of stay (>75th percentile).


RESULTS
None of the procedures had higher operative mortality rates at teaching hospitals. In unadjusted analyses, pancreatic resection (4.0% vs 8.8%; P<.001), hepatic resection (5.3% vs 8.0%; P =.03), and esophageal resection (7.7% vs 10.2%; P =.10) had lower operative mortality rates at teaching compared with nonteaching hospitals. However, after adjusting for hospital volume in the multivariate analysis, hospital teaching status was no longer a predictor of operative mortality.


CONCLUSIONS
Teaching hospitals have lower operative mortality rates for complex surgical procedures. However, the lower mortality rates at teaching hospitals can be explained by higher procedural volume.
Dimick
Justin B
JB
Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA. jdimick@umich.edu
Cowan
John A
JA
Colletti
Lisa M
LM
Upchurch
Gilbert R
GR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016629:Esophagectomy / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006498:Hepatectomy / Q000401:mortality / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends*; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality / Q000706:statistics & numerical data; D011336:Probability; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D018709:Statistics, Nonparametric; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology