Hospital teaching intensity, patient race, and surgical outcomes.
OBJECTIVE
To determine if the lower mortality often observed in teaching-intensive hospitals is because of lower complication rates or lower death rates after complications (failure to rescue) and whether the benefits at these hospitals accrue equally to white and black patients, since black patients receive a disproportionate share of their care at teaching-intensive hospitals.


METHODS
A retrospective study of patient outcomes and teaching intensity using logistic regression models, with and without adjusting for hospital fixed and random effects.


METHODS
Three thousand two hundred seventy acute care hospitals in the United States.


METHODS
Medicare claims on general, orthopedic, and vascular surgery admissions in the United States for 2000-2005 (N = 4,658,954 unique patients).


METHODS
Thirty-day mortality, in-hospital complications, and failure to rescue (the probability of death following complications).


RESULTS
Combining all surgeries, compared with nonteaching hospitals, patients at very major teaching hospitals demonstrated a 15% lower odds of death (P < .001), no difference in complications, and a 15% lower odds of death after complications (failure to rescue) (P < .001). These relative benefits associated with higher resident-to-bed ratio were not experienced by black patients, for whom the odds of mortality and failure to rescue were similar at teaching and nonteaching hospitals, a pattern that is significantly different from that of white patients (P < .001).


CONCLUSIONS
Survival after surgery is higher at hospitals with higher teaching intensity. Improved survival is because of lower mortality after complications (better failure to rescue) and generally not because of fewer complications. However, this better survival and failure to rescue at teaching-intensive hospitals is seen for white patients, not for black patients.
Silber
Jeffrey H
JH
Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market St, Ste 1029, Philadelphia, PA 19104, USA. silberj@wharton.upenn.edu
Rosenbaum
Paul R
PR
Romano
Patrick S
PS
Rosen
Amy K
AK
Wang
Yanli
Y
Teng
Yun
Y
Halenar
Michael J
MJ
Even-Shoshan
Orit
O
Volpp
Kevin G
KG
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology