Impact of hospital teaching status on length of stay and mortality among patients undergoing complex hepatopancreaticobiliary surgery in the USA.
OBJECTIVE
To define the impact of hospital teaching status on length of stay and mortality for patients undergoing complex hepatopancreaticobiliary (HPB) surgery in the USA.


METHODS
Using the Nationwide Inpatient Sample, we identified 285,442 patient records that involved a liver resection, pancreatoduodenectomy, other pancreatic resection, or hepaticojejunostomy between years 2000 and 2010. Year-wise distribution of procedures at teaching and non-teaching hospitals was described. The impact of teaching status on in-hospital mortality for operations performed at hospitals in the top tertile of procedure volume was determined using multivariate logistic regression analysis.


RESULTS
A majority of patients were under 65 years of age (59.6 %), white (74.0 %), admitted on an elective basis (77.3 %), and had a low comorbidity burden (70.5 %). Ninety percent were operated upon at hospitals in the top tertile of yearly procedure volume. Among patients undergoing an operation at a hospital in the top tertile of procedure volume (>25/year), non-teaching status was associated with an increased risk of in-hospital death (OR 1.47 [1.3, 1.7]). Other factors associated with increased risk of mortality were older patient age (OR 2.52 [2.3, 2.8]), male gender (OR 1.73 [1.6, 1.9]), higher comorbidity burden (OR 1.49 [1.3, 1.7]), non-elective admission (OR 3.32 [2.9, 4.0]), and having a complication during in-hospital stay (OR 2.53 [2.2, 3.0]), while individuals with private insurance had a lower risk of in-hospital mortality (OR 0.45 [0.4, 0.5]). After controlling for other covariates, undergoing complex HPB surgery at a non-teaching hospital remained independently associated with 32 % increased odds of death as (OR 1.32, 95 % CI 1.11-1.58; P < 0.001).


CONCLUSIONS
Even among high-volume hospitals, patients undergoing complex HPB have better outcomes at teaching vs. non-teaching hospitals. While procedural volume is an established factor associated with surgical outcomes among patients undergoing complex HPB procedures, other hospital-level factors such as teaching status have an important impact on peri-operative outcomes.
Department of Surgery, School of Medicine, Johns Hopkins University, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Omar
O
Hyder
Teviah
T
Sachs
Aslam
A
Ejaz
Gaya
G
Spolverato
Timothy M
TM
Pawlik
D013505:Digestive System Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D014481:United States