Which hospitals have more problems after surgery?

NEW YORK Wed Apr 27, 2011 4:44pm EDT

Surgery instruments are pictured during procedures to clean the wound of an amputee patient with MRSA (Methicillin resistant Staphylococcus Aureus) in the operating theatre at the Unfallkrankenhaus Berlin (UKB) hospital in Berlin February 29, 2008. REUTERS/Fabrizio Bensch

Surgery instruments are pictured during procedures to clean the wound of an amputee patient with MRSA (Methicillin resistant Staphylococcus Aureus) in the operating theatre at the Unfallkrankenhaus Berlin (UKB) hospital in Berlin February 29, 2008.

Credit: Reuters/Fabrizio Bensch

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NEW YORK (Reuters Health) - A new study finds mixed results in the rates of death and complications after surgery at hospitals that train doctors versus those that don't.

Teaching hospitals have more deaths after emergency surgery than non-teaching hospitals, while both types of hospitals have similar risks of dying after elective surgeries, according to research published in the May issue of the Annals of Surgery.

The researchers analyzed a nationwide database of hospitalizations from 2000 to 2006 that included one out of every five hospitals in the United States.

According to the Association of American Medical Colleges, there are more than 1,000 teaching hospitals in the United States, comprising a little more than a fifth of the country's hospitals.

The study found that, at teaching hospitals, the chance of dying after an emergency surgery was 20 percent higher than at non-teaching hospitals.

Twenty-eight patients out of every 1,000 who had emergency surgery at academic centers died in the hospital, while 23 out of every 1,000 patients at non-teaching hospitals died.

Dr. Rachel Kelz, a professor at the University of Pennsylvania School of Medicine and the senior author of the study, said she doesn't have a good explanation for the increased risk of death after emergency surgery at teaching hospitals.

The difference could be due to teaching hospitals getting more sick patients, something her study did not account for, Kelz told Reuters Health.

Patients could have the same illness, say, cancer, but the data don't reveal how severe the cancer is.

Dr. Justin Dimick, a surgery professor at the University of Michigan, who was not involved in the study, agreed that the results might not reflect the types of patients who go to teaching hospitals.

"We all get the sense that the teaching hospitals end up getting the most complex cases," he said.

Both Dimick and Kelz work at teaching hospitals.

Dimick added that he was surprised to see the death rate higher at teaching hospitals, because it runs counter to what previous studies have found.

For complex surgeries at teaching hospitals, for instance, an older study Dimick conducted found that patients had a smaller chance of dying. He and his colleagues also reported in March that having a doctor-in-training involved in a surgery was linked with a smaller chance of death.

"It would be a mistake to look at these findings and say teaching hospitals are unsafe for surgery," Dimick told Reuters Health.

Some complications were more likely to occur at teaching hospitals, while just one was more common at non-teaching hospitals.

Of 11 complications the researchers measured, intestinal blockage after emergency surgery was 18 percent less likely at teaching hospitals than at non-teaching hospitals.

For elective surgeries, two complications - abnormal growths and infections - were more likely at teaching hospitals. Abnormal growth (called a fistula) was 56 percent more likely and infections were 14 percent more likely at teaching hospitals.

Kelz said that patients should not base their choice of hospital on these findings.

Rather, the results might be useful in helping hospitals look at whether others are doing something better.

"It's important to identify areas where there's a potential to improve outcomes, but the study doesn't say what causes the differences," Kelz said.

SOURCE: bit.ly/m2qBsm Annals of Surgery, May 2011.

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Comments (4)
panderso wrote:
A fistula is NOT a growth. A fistula is an abnormal site of drainage. When occurring as a complication of surgery, it is a leaking incision line that often is result of an error in the surgeon’s technique while closing that incision. Observing that teaching hospitals, where inexperienced surgeons are doing the sewing, had more than 50% greater incidence of fistulas, the implications should be obvious –( despite their professors attempts to spin the results otherwise). More experienced hands are doing the actual surgery in non-teaching hospitals.

Apr 28, 2011 2:12am EDT  --  Report as abuse
griinincat wrote:
“The difference could be due to teaching hospitals getting more sick patients, something her study did not account for, Kelz told Reuters Health.”

This is a major design flaw in the study that largely invalidates the study results. One would hope that an experienced researcher would control for such an obvious variable and that those peer-reviewing the study would raise it as an issue to be corrected prior to publication. If patients at teaching hospitals were sicker on average than those at non-teaching hospital, that alone could explain the reported results.

Apr 28, 2011 11:10am EDT  --  Report as abuse
danwalter wrote:
This is certainly the case at Johns Hopkins: http://collateral-damage.net

Apr 28, 2011 2:01pm EDT  --  Report as abuse
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