title: Appendicitis outcomes are better at resident teaching institutions: a multi-institutional analysis.
abstract: BACKGROUND
  This study compared the outcomes of appendicitis between teaching and nonteaching institutions.
  
  
  METHODS
  A retrospective review was performed of all appendicitis patients aged >18 years from 1998 to 2007. The outcomes from 2 teaching institutions (each with its own general surgery residency program) were compared with those from 11 nonteaching institutions. Study outcomes included postoperative morbidity and length of hospitalization.
  
  
  RESULTS
  A total of 3,242 patients were treated at the teaching institutions (mean age, 41 years; 61% men) and 14,483 at the nonteaching institutions (mean age, 38 years; 54% men). The perforated appendicitis rate was 29% at the teaching institution and 28% at the nonteaching institutions (P = .20). For nonperforated appendicitis, there was no difference in the incidence of wound infection between the teaching and nonteaching institutions (2.7% vs 2.3%, P = .30). There was a lower rate of abscess drainage (.4% vs 1%, P = .02), a lower readmission rate (1.7% vs 3.5%, P < .0001), and shorter lengths of stay (1.7 ± 1.5 vs 1.8 ± 1.6 days, P = .002) at teaching institutions. For perforated appendicitis, there were also lower rates of wound infection (4.8% vs 7%, P = .03), abscess drainage (4.9% vs 10%, P < .0001), and need for readmission (4.2% vs 8.4%, P < .0001) at the teaching hospitals. The lengths of stay were similar (5.0 ± 4.2 vs 5.2 ± 3.1 days, P = .30). Use of laparoscopy was lower and nonoperative management of perforated appendicitis higher at the teaching hospitals.
  
  
  CONCLUSIONS
  Teaching institutions were more likely to perform appendectomy using an open technique and to manage perforated appendicitis nonoperatively. Infectious complications and readmission rates for both perforated and nonperforated appendicitis were lower at teaching institutions.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Arezou
authors.initials: A
authors.lastname: Yaghoubian
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lee
mesh_terms: D000038:Abscess / Q000209:etiology; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000193:education; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011787:Quality of Health Care; D013530:Surgical Wound Infection; D016896:Treatment Outcome