Lab Soft News: High Risk Surgical Patients Have Lower Mortality Rates at Major Teaching Hospitals

I firmly believe that it's important to get oneself to a major teaching hospital if you fall into the category of a high risk, general surgery patient. A recent article put some numbers to this advice (see: High risk patients have lower mortality rates at major teaching hospitals). Below is an excerpt from the article:

New research published in the Annals of Surgery shows that high-risk general surgery patients have greater survival rates at major teaching hospitals than at non-teaching hospitals....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....They 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 study examined costs and patient outcomes—including 30-day mortality rates—for procedures, such as mastectomy, appendectomy, gastric bypass, blood vessel repair, total knee replacement, and more. The researchers calculated the cost of care within 30 days of admission, including office visits and readmissions....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 overall than the rates for vascular and general surgery.

In my view, the reason why major teaching hospitals provide better care for high risk surgical patients is that academic physicians tend to be more specialized than community physicians. Because of this orientation, they are more apt to be knowledgeable about new technology and techniques relating to a particular surgery and some surgeons may have performed a procedure very frequently because of this specialization. Another factor leading to lower mortality is that teaching hospitals have an organizational hierarchy with multiple layers of oversight including house officers and staff surgeons. Absent such oversight, physician incompetence can be overlooked or intentionally disregarded. One of my recent notes about malpractice in a VA hospital provides an extreme example of the consequences of weak physician oversight (see: VA Pathologist Indicted for Multiple and Continuing Errors, Resulting in Deaths).

The flip slide of this coin about which hospitals to patronize is that major teaching hospitals may provide lesser quality service for common conditions (see: Teaching Hospitals and Quality of Care: A Review of the Literature). Below is an excerpt from this article:

Despite their reputation for highly specialized care and for treating rare diseases and severely ill patients, teaching hospitals in fact rely heavily on income from more routine services, such as the care of heart disease, pneumonia, and stroke....It is possible, however, that for common conditions, teaching hospitals may offer a lower quality of care than do nonteaching hospitals, particularly if the substantial involvement of inexperienced trainees and the attenuated role of senior physicians in teaching hospitals results in more fragmented and less appropriate care. Both purchasers and patients have an interest in knowing whether teaching hospitals provide added value through a higher quality of care or whether services of comparable quality could be obtained at a lower cost in nonteaching hospitals.

Bottom line and to repeat comments above: If you are a high risk surgical patient, you can reduce the likelihood of a bad outcome by seeking care in a major teaching hospital.