White patients benefit more than blacks in surviving surgical complications at teaching hospitals

Feb 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 these results. Unlike whites, for black patients, the odds of death, complication and failure to rescue were similar at both teaching and nonteaching hospitals.

Silber's group did not find lower rates of complications in teaching-intensive hospitals. "Overall, the improved survival rates were not because patients were less likely to have complications, but because they were less likely to die from those complications in teaching hospitals," said Silber, who first developed failure-to-rescue as a quality of care measure more than a decade ago. The National Quality Forum subsequently adopted it as a hospital quality indicator.

Black patients displayed higher complication rates than white patients at both teaching and nonteaching hospitals, though there was no difference in complication rates between teaching and nonteaching hospitals for both black or white patients. While white patients at teaching hospitals experienced better survival rates after complications than black patients when compared to nonteaching hospitals, black patients experienced the same survival after complications at both types of hospitals. The researchers found this racial disparity existed not only across different hospitals, but also for white and black patients within the same hospitals.

"We don't yet know why these racial disparities exist in surgical outcomes, but we have some working hypotheses," said Silber. His group offers possible explanations, such as unintentional differences in communication between patients and providers. Also, in previous work, Silber and colleagues found that surgical procedures take longer for black patients than white patients in some hospitals. "That finding raised the question of whether less experienced physicians might be more often operating on black patients," he added.

However, Silber noted, the current study relied on Medicare claims data, not on detailed medical records, so it did not provide specific information on patient care that might shed light on the reasons for the observed racial disparities. "Our findings provide a starting point for further studies of detailed patient care that might shed light on why these disparities exist and how they could be reduced."

Source: Children's Hospital of Philadelphia

Explore further: Strategies can help docs lower their tax burden

add to favorites email to friend print save as pdf

Related Stories

Team improves solar-cell efficiency

5 hours ago

New light has been shed on solar power generation using devices made with polymers, thanks to a collaboration between scientists in the University of Chicago's chemistry department, the Institute for Molecular ...

Calif. teachers fund to boost clean energy bets

5 hours ago

The California State Teachers' Retirement System says it plans to increase its investments in clean energy and technology to $3.7 billion, from $1.4 billion, over the next five years.

Alibaba surges in Wall Street debut

5 hours ago

A buying frenzy sent Alibaba shares sharply higher Friday as the Chinese online giant made its historic Wall Street trading debut.

Dwindling wind may tip predator-prey balance

5 hours ago

Bent and tossed by the wind, a field of soybean plants presents a challenge for an Asian lady beetle on the hunt for aphids. But what if the air—and the soybeans—were still?

Recommended for you

The human race evolved to be fair for selfish reasons

Sep 19, 2014

"Make sure you play fairly," often say parents to their kids. In fact, children do not need encouragement to be fair, it is a unique feature of human social life, which emerges in childhood. When given the o ...

Non-stop PET/CT scan provides accurate images

Sep 18, 2014

Siemens is improving PET/CT imaging and data quality while reducing radiation exposure. The Biograph mCT Flow PET/CT scanner is a new positron emission tomography/computed tomography (PET/CT) system that, ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

holmstar
5 / 5 (1) Feb 16, 2009
I'd like to see data comparing the rate of complications for specific procedures, rather than as a whole. Also, not all teaching hospitals can be considered equal, and the demographics of a particular hospitals patients can vary considerably. I suspect that these researchers have a lot more work to do before they can make the kind of conclusions that they appear to be making.