Teaching Hospital Status and Operative Mortality in the United States

Abstract

Objective To compare risk- and volume-adjusted outcomes of colon resections performed at teaching hospitals (THs) vs non-THs to assess whether benign disease may influence the volume-outcome effect. Design Retrospective data analysis examining colon resections determined by International Classification of Diseases, Ninth Revision, Clinical Modification classification performed in the United States from 2001 through 2005 using the Nationwide Inpatient Sample (NIS) and the Area Resource File (2004). Patient covariates used in adjustment included age, sex, race, Charlson Index comorbidity score, and insurance status. Hospital covariates included TH status, presence of a colorectal surgery fellowship approved by the Accreditation Council for Graduate Medical Education, geographical region, institutional volume, and urban vs rural location. County-specific surgeon characteristics used in adjustment included average age of surgeons and proportion of colorectal board-certified surgeons within each county. Environmental or county covariates included median income and percentage of county residents living below the federal poverty level. Setting A total of 1045 hospitals located in 38 states in the United States that were included in the NIS. Patients All patients older than 18 years who had colon resection and were discharged from a hospital included in the NIS. Main Outcome Measures Operative mortality, length of stay (LOS), and total charges. Results A total of 115 250 patients were identified, of whom 4371 died (3.8%). The mean LOS was 10 days. Fewer patients underwent surgical resection in THs than in non-THs (46 656 vs 68 589). Teaching hospitals were associated with increased odds of death (odds ratio, 1.14) (P=.03), increased LOS (P=.003), and a nonsignificant trend toward an increase in total charges (P=.36). Conclusions With the inclusion of benign disease, colon surgery displays a volume-outcome relationship in favor of non-THs. Inclusion of benign disease may represent a tipping point.

Predictors of Lymph Node Count in Colorectal Cancer Resections

“…46-49 Previous studies have reported that the recovered node count is positively associated with specimen length, 14,18,19,21-24 proximal colon cancer, 13,18,19,25,28 larger tumor size, 11,14,18,20 number of vascular pedicles, 50 and higher disease stage. 17,18 However, in those studies, 11,13,14,17-24,28 there were no data on host immune response to tumor, or tumor molecular features, despite possible influence of immune reaction and tumor molecular variables on the node count.…”

Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population

“…The ARF database is a collection of data from more than 50 sources, including the American Medical Association, the US Census Bureau, and the Centers for Medicare & Medicaid Services, and has more than 6000 county aggregate variables, including health measures. These data have been used frequently in prior studies of CRC testing (Hayanga et al, 2010; Koroukian et al, 2005, 2006). Second, we used historical SMFP data to identify endoscopy centers across the state and called each of these centers to verify information contained in the archived SMFP records, including, but not limited to, facility street addresses, (which were needed for geocoding), affiliate facilities (where applicable), and procedures performed.…”

Predictors of increased costs following index adult cardiac operations: Insights from a statewide publicly reported registry

“…Our data demonstrates that nonteaching hospital status was a significant predictor of increased costs for isolated CABG. While the literature is limited regarding analyses for teaching status and costs specifically for isolated CABG, most studies in other surgical fields have identified teaching hospitals as having higher costs, which is the opposite of our findings . One aspect that may contribute to this discrepancy is that our study involved only 13 nonteaching hospitals, and if expanded to a larger cohort of hospitals, it is unclear if this finding would persist.…”