Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 12/2013

01-12-2013 | Original Article

Impact of Hospital Teaching Status on Length of Stay and Mortality Among Patients Undergoing Complex Hepatopancreaticobiliary Surgery in the USA

Authors: Omar Hyder, Teviah Sachs, Aslam Ejaz, Gaya Spolverato, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 12/2013

Login to get access

Abstract

Objective

To define the impact of hospital teaching status on length of stay and mortality for patients undergoing complex hepatopancreaticobiliary (HPB) surgery in the USA.

Methods

Using the Nationwide Inpatient Sample, we identified 285,442 patient records that involved a liver resection, pancreatoduodenectomy, other pancreatic resection, or hepaticojejunostomy between years 2000 and 2010. Year-wise distribution of procedures at teaching and non-teaching hospitals was described. The impact of teaching status on in-hospital mortality for operations performed at hospitals in the top tertile of procedure volume was determined using multivariate logistic regression analysis.

Results

A majority of patients were under 65 years of age (59.6 %), white (74.0 %), admitted on an elective basis (77.3 %), and had a low comorbidity burden (70.5 %). Ninety percent were operated upon at hospitals in the top tertile of yearly procedure volume. Among patients undergoing an operation at a hospital in the top tertile of procedure volume (>25/year), non-teaching status was associated with an increased risk of in-hospital death (OR 1.47 [1.3, 1.7]). Other factors associated with increased risk of mortality were older patient age (OR 2.52 [2.3, 2.8]), male gender (OR 1.73 [1.6, 1.9]), higher comorbidity burden (OR 1.49 [1.3, 1.7]), non-elective admission (OR 3.32 [2.9, 4.0]), and having a complication during in-hospital stay (OR 2.53 [2.2, 3.0]), while individuals with private insurance had a lower risk of in-hospital mortality (OR 0.45 [0.4, 0.5]). After controlling for other covariates, undergoing complex HPB surgery at a non-teaching hospital remained independently associated with 32 % increased odds of death as (OR 1.32, 95 % CI 1.11–1.58; P < 0.001).

Conclusions

Even among high-volume hospitals, patients undergoing complex HPB have better outcomes at teaching vs. non-teaching hospitals. While procedural volume is an established factor associated with surgical outcomes among patients undergoing complex HPB procedures, other hospital-level factors such as teaching status have an important impact on peri-operative outcomes.
Literature
1.
Data on teaching hospitals and charity care, 2010, Association of American Medical Colleges.
2.
Sorra, J., et al., Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report, 2012, Agency for Healthcare Research and Quality: Rockville, MD.
3.
Khuri, S.F., et al., Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg, 2001. 234(3): p. 370–82.PubMedCrossRef
4.
Stewart, D.B., et al., Rectal Cancer and Teaching Hospitals: Hospital Teaching Status Affects Use of Neoadjuvant Radiation and Survival for Rectal Cancer Patients. Annals of Surgical Oncology, 2013. 20(4): p. 1156–1163.PubMedCrossRef
5.
Grosskopf, S., D. Margaritis, and V. Valdmanis, Comparing teaching and non-teaching hospitals: a frontier approach (teaching vs. non-teaching hospitals). Health Care Manag Sci, 2001. 4(2): p. 83–90.PubMedCrossRef
6.
Koval, K.J., C.L. Rust, and K.F. Spratt, The effect of hospital setting and teaching status on outcomes after hip fracture. Am J Orthop (Belle Mead NJ), 2011. 40(1): p. 19–28.
7.
Lee, S.L., A. Yaghoubian, and C. de Virgilio, A Multi-Institutional Comparison of Pediatric Appendicitis Outcomes Between Teaching and Nonteaching Hospitals. Journal of Surgical Education, 2011. 68(1): p. 6–9.PubMedCrossRef
8.
Meguid, R.A., et al., Are surgical outcomes for lung cancer resections improved at teaching hospitals? Annals of Thoracic Surgery, 2008. 85(3): p. 1015–1025.PubMedCrossRef
9.
Dimick, J.B., et al., Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg, 2004. 139(2): p. 137–41.PubMedCrossRef
10.
Hyder, O., et al., A risk model to predict 90-day mortality among patients undergoing hepatic resection. J Am Coll Surg, 2013. 216(6): p. 1049–56.PubMedCrossRef
11.
Bhayani, N.H., et al., Effect of metabolic syndrome on perioperative outcomes after liver surgery: A National Surgical Quality Improvement Program (NSQIP) analysis. Surgery, 2012. 152(2): p. 218–26.PubMedCrossRef
12.
Schwartz, G.S., et al., Morbidity and mortality after hepatic and pancreatic resections: results from one surgeon at a low-volume urban hospital over thirty years. Am J Surg, 2011. 201(4): p. 438–44.PubMedCrossRef
13.
Sato, M., et al., Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients. J Gastroenterol, 2012. 47(10): p. 1125–33.PubMedCrossRef
14.
Kim, J.H., et al., Surgical Outcomes of Distal Pancreatectomy. Hepatogastroenterology, 2013. 60(126).
15.
Zhou, W., et al., Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg, 2010. 200(4): p. 529–36.PubMedCrossRef
16.
Schneider, E.B., et al., Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies. J Am Coll Surg, 2012. 215(5): p. 607–15.PubMedCrossRef
17.
Schneider, E.B., et al., Provider versus patient factors impacting hospital length of stay after pancreaticoduodenectomy. Surgery, 2013.
18.
McPhee, J.T., et al., Perioperative mortality for pancreatectomy: a national perspective. Ann Surg, 2007. 246(2): p. 246–53.PubMedCrossRef
19.
Kohn, G.P. and M. Nikfarjam, The effect of surgical volume and the provision of residency and fellowship training on complications of major hepatic resection. J Gastrointest Surg, 2010. 14(12): p. 1981–9.PubMedCrossRef
20.
21.
Natarajan, S., et al., An extension of the Wilcoxon rank sum test for complex sample survey data. Journal of the Royal Statistical Society Series C-Applied Statistics, 2012. 61: p. 653–664.CrossRef
22.
Nathan, H., et al., The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg, 2009. 208(4): p. 528–38.PubMedCrossRef
23.
Kim, C.G., S. Jo, and J.S. Kim, Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy. World J Gastroenterol, 2012. 18(31): p. 4175–81.PubMedCrossRef
24.
Dimick, J.B., et al., Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg, 2003. 138(2): p. 185–91.PubMedCrossRef
25.
Fisher, S.B., et al., A comparison of right posterior sectorectomy with formal right hepatectomy: a dual-institution study. HPB (Oxford), 2013.
26.
Jha, A.K., et al., The long-term effect of premier pay for performance on patient outcomes. N Engl J Med, 2012. 366(17): p. 1606–15.PubMedCrossRef
27.
AHRQuality Indicators—Inpatient Quality Indicators Technical Specifications—Rockville, Maryland: Agency for Healthcare Research and Quality; Version 4.5, May 2013.
28.
Milstein, A., et al., Improving the safety of health care: the leapfrog initiative. Eff Clin Pract, 2000. 3(6): p. 313–6.PubMed
29.
Mueller, S.K., S. Lipsitz, and L.S. Hicks, Impact of hospital teaching intensity on quality of care and patient outcomes. Med Care, 2013. 51(7): p. 567–74.PubMedCrossRef
30.
Dimick, J.B., H.G. Welch, and J.D. Birkmeyer, Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA, 2004. 292(7): p. 847–51.PubMedCrossRef
31.
Gopaldas, R.R., et al., Impact of surgeon demographics and technique on outcomes after esophageal resections: a nationwide study. Ann Thorac Surg, 2013. 95(3): p. 1064–9.PubMedCrossRef
32.
Ben-Haim, M., R. Nakache, and J.M. Klausner, [Hepato-pancreato-biliary (HPB) surgery and abdominal organ transplantation, a defined subspecialty, integrated within the surgical division: professional, operative and educational aspects]. Harefuah, 2009. 148(4): p. 215–8, 278.PubMed
33.
Csikesz, N.G., et al., Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg, 2008. 12(9): p. 1534–9.PubMedCrossRef
34.
Taylor, D.H., Jr., D.J. Whellan, and F.A. Sloan, Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. N Engl J Med, 1999. 340(4): p. 293–9.PubMedCrossRef
35.
Castleberry, A.W., et al., Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery. Ann Surg Oncol, 2013.
36.
Kiran, R.P., et al., Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program. Ann Surg, 2012. 256(3): p. 469–75.PubMedCrossRef
37.
Jurgaitis, J., et al., Controlled-surgical education in clinical liver transplantation is not associated with increased patient risks. Clin Transplant, 2006. 20 Suppl 17: p. 69–74.PubMedCrossRef
38.
Nathan, H. and T.M. Pawlik, Limitations of claims and registry data in surgical oncology research. Annals of Surgical Oncology, 2008. 15(2): p. 415–23.PubMedCrossRef
39.
40.
Billingsley, K.G., et al., Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg, 2007. 142(1): p. 23–31; discussion 32.PubMedCrossRef
Metadata
Title
Impact of Hospital Teaching Status on Length of Stay and Mortality Among Patients Undergoing Complex Hepatopancreaticobiliary Surgery in the USA
Authors
Omar Hyder
Teviah Sachs
Aslam Ejaz
Gaya Spolverato
Timothy M. Pawlik
Publication date
01-12-2013
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 12/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-013-2349-4

Other articles of this Issue 12/2013

Journal of Gastrointestinal Surgery 12/2013 Go to the issue

GI Image

Gastric Schwannoma: A Rare Find

How I Do It

Surgical Management of Retroperitoneal Leiomyosarcoma Arising from the Inferior Vena Cava

Review Article

Selective Decontamination of the Digestive Tract in Gastrointestinal Surgery: Useful in Infection Prevention? A Systematic Review

Original Article

Fully Covered Self-Expanding Metal Stents Are Effective For Benign Esophagogastric Disruptions and Strictures

2012 SSAT Quick Shot Presentation

Anatomophysiology of the Pharyngo-Upper Esophageal Area in Light of High-Resolution Manometry

Original Article

Ezrin Expression Is an Independent Prognostic Factor in Gastro-intestinal Cancers