White Patients Benefit More Than Blacks in Surviving Surgical Complications at Teaching Hospitals, Study Finds
Elderly patients who undergo surgery at teaching-intensive hospitals have better survival rates than at non-teaching hospitals, but these better survival rates occur in white patients, not black patients, according to a study co-authored by a BUSPH researcher.
“Survival after surgery is higher at hospitals with higher teaching intensity,” according to the study, which appears in the February issue of the Archives of Surgery and was co-authored by Amy Rosen, a professor of Health Policy & Management at BUSPH and director of risk assessment and patient safety for the VA’s Center for Health Quality, Outcomes and Economic Research in Bedford, Mass.
“Improved survival is because of lower mortality after complications…and generally not because of fewer complications,” the authors said. “However, this better survival and failure to rescue (rate) at teaching-intensive hospitals is seen for white patients, not for black patients.”
The research team, led by Jeffrey H. Silber, MD, director of the Center for Outcomes Research at The Children’s Hospital of Philadelphia, analyzed Medicare claims from 4.6 million patients, aged 65 to 90, who were admitted for general, orthopedic and vascular surgery at 3,270 acute care hospitals in the U.S. from 2000 to 2005. Hospitals were classified as non-teaching hospitals if they had no medical residents, and teaching hospitals were scaled by their ratio of residents to hospital beds
The research team, led by Jeffrey H. Silber, MD, director of the Center for Outcomes Research at The Children’s Hospital of Philadelphia, analyzed Medicare claims from 4.6 million patients, aged 65 to 90, who were admitted for general, orthopedic and vascular surgery at 3,270 acute care hospitals in the U.S. from 2000 to 2005. Hospitals were classified as non-teaching hospitals if they had no medical 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 non-teaching 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. Unlike whites, for black patients, the odds of death, complication and failure-to-rescue were similar at both teaching and non-teaching hospitals. The associations were adjusted for patient illness on admission; adjusting for income level did not change the results.
Black patients displayed higher complication rates than white patients at both teaching and non-teaching hospitals, although there was no difference in complication rates between teaching and non-teaching hospitals for black or white patients. While white patients at teaching hospitals experienced better survival rates after complications than black patients when compared to non-teaching 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.
“Why racial differences in failure-to-rescue should occur within hospitals is not well understood, but there are many possibilities,” the authors wrote. They offered as a possible explanation 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.
Funding for the study came from the National Heart, Lung, and Blood Institute of the National Institutes of Health, the U.S. Department of Veterans Affairs and the National Science Foundation.
Submitted by Lisa Chedekel, chedekel@bu.edu