Non-Teaching Hospitals Found Superior for Colon Resection

Teaching, non-teaching hospitals evaluated for mortality, length of stay, costs
By Jeff Muise
HealthDay Reporter

WEDNESDAY, April 21 (HealthDay News) -- For colon resections across the spectrum of disease -- including benign disease -- the volume-outcome relationship favors non-teaching hospitals over teaching hospitals, according to research published in the April issue of the Archives of Surgery.

Awori J. Hayanga, M.D., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues analyzed data from 1,045 hospitals on 115,250 patients who underwent colon resections, including procedures for both malignant and benign conditions, performed in the United States during 2001 to 2005. The researchers compared operative mortality, hospital length of stay, and total charges for teaching hospitals and non-teaching hospitals, and evaluated the volume-outcome relationship.

The researchers calculated an overall mortality rate of 3.8 percent, a mean length of stay of 10 days, and median charges of $33,611 for colon resection. Fewer patients underwent colon resection in teaching hospitals than non-teaching hospitals (46,656 versus 68,589). Compared with non-teaching hospitals, teaching hospitals were associated with increased odds of death (odds ratio, 1.14; P = .03), longer hospital stays (0.52 days longer; P = .003), and a nonsignificant trend toward higher costs ($33,640 for teaching hospitals versus $33,596 for non-teaching hospitals; P = .36).

"Teaching hospitals offer improved outcomes for complex oncologic surgical resections such as esophageal and pancreatic surgery but may offer worse outcomes for less complex surgery such as colon surgery, the bulk of which is performed at non-teaching hospitals, which are less reliant on complex processes of care. We suspect that the inclusion of benign surgical disease with an attendant decrease in morbidity and mortality may be responsible for creating a tipping point that shifts the volume-outcome ratio in favor of non-teaching hospitals," the authors write.

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