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White patients benefit more than blacks in surviving surgical complications at teaching hospitals
Date:2/16/2009

Elderly patients who undergo surgery at teaching-intensive hospitals have better survival rates than at nonteaching hospitals, but these better survival rates apparently occur in white patients, not black patients.

"We found an advantage in surgical outcomes for patients in teaching-intensive hospitals compared to nonteaching hospitals, as we had expected from other studies," said study leader Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children's Hospital of Philadelphia, and a professor at the University of Pennsylvania. "What we didn't expect was that better outcomes in teaching hospitals occurred for white patients but not for black patients." Furthermore, he added, the survival advantage from teaching hospitals came from lower death rates after complications (lower rates of a measurement called "failure-to-rescue"), not from lower complication rates.

The study appears in the February issue of the Archives of Surgery.

The study group analyzed Medicare claims from 4.6 million patients aged 65 to 90 admitted for general, orthopedic and vascular surgery at 3,270 acute care hospitals in the United States from 2000 to 2005. Hospitals were classified as nonteaching hospitals if they had no residents, and teaching hospitals were scaled by their ratio of residents to hospital beds.

The researchers measured mortality 30 days after surgery, in-hospital complications and failure-to-rescue, defined as the probability of death following complications. They found that compared to nonteaching hospitals, hospitals with the highest ratio of residents to beds had 15 percent lower mortality after surgery, no difference in complications, and 15 percent lower odds of death after complications (failure-to-rescue). However, these benefits were observed in white patients, not black patients. These associations were adjusted for patient illness on admission, and adjusting for income level did not change
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Contact: John Ascenzi
Ascenzi@email.chop.edu
267-426-6055
Children's Hospital of Philadelphia
Source:Eurekalert

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