High-risk patients have lower mortality rates at major teaching hospitals

By John Commons, HealthLeaders Media

High-risk general surgery patients have higher survival rates at major teaching hospitals than at non-teaching hospitals, new research shows.

The 30-day mortality rate for these high-risk patients was 15.9% at major teaching hospitals, compared with 18.2% at non-teaching hospitals, according to researchers at Penn Medicine, who examined the medical records of 350,000 Medicare beneficiaries who underwent general, vascular or orthopedic surgery at 2,780 hospitals across the country, including 340 major teaching hospitals.

The findings were published this month in Annals of SurgeryThe study was funded in part by the Association of American Medical Colleges.

Major teaching hospitals were defined by the researchers as having a resident-to-bed ratio of greater than .25. "Academic medical centers are often recognized for their ability to deliver advanced clinical and surgical care, but there has been limited data on which specific patient groups benefit the most—when factoring costs and outcomes—from receiving care at the hospitals," senior author Lee A. Fleisher, MD, said in comments accompanying the study.

"Our study showed that as the severity of a patient’s medical condition worsened and the complexity of the surgery increased, the benefit of undergoing general or vascular surgery at a teaching hospital also increased," said Fleisher, chair of Anesthesiology and Critical Care at Penn.

The study examined costs and patient outcomes—including 30-day mortality rates—for dozens of procedures, such as mastectomy, appendectomy, gastric bypass, blood vessel repair and total knee replacement.

The researchers calculated the cost of care within 30 days of admission, including office visits and readmissions. Researchers matched pairs of individuals based on the procedure, risk profile and factors related to their medical history, including comorbidities such as diabetes and high blood pressure.

The mortality rate of high-risk vascular surgery patients was 15.5% at teaching hospitals compared to 16.4% at non-teaching hospitals. The mortality rate for orthopedic surgery procedures was significantly lower across the board than the rates for vascular and general surgery.

To calculate the cost for a 1% reduction in mortality rates, the researchers divided the variations in resource costs at major teaching and non-teaching hospitals by the difference in 30-day mortality rates. Under that equation, the value for general surgery was $965 for a 1% reduction in mortality, while the estimate for vascular surgery was $3,567.

"Our study provides new data that can help inform patient decisions and influence hospital referral patterns, ultimately moving us closer to a system that ensures patients have access to the treatment they need," Fleisher said.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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Patient Safety, Quality Improvement