The majority of patients who undergo colon resection at arguably smaller, less sophisticated nonteaching hospitals may be making a wise choice, according to a new study revealing that patients are more likely to die after the procedure at teaching hospitals.
The study, published in the April issue of the journal Archives of Surgery, analyzed data from 115,250 patients who had part of their colon removed for both cancerous and non-cancerous diseases at 1,045 hospitals in 38 states from 2001 through 2005. The 46,656 patients who had their surgery at a teaching hospital had a 10.5 day average length of stay and a 3.9 percent risk of death. In comparison, the 68,589 undergoing the procedure at nonteaching hospitals stayed in the hospital an average of 10 days and had a lower, 3.7 percent risk of dying.
"While the volume-outcome relationship may favor colon cancer resections performed in teaching hospitals, this advantage might be lost when benign colon disease is factored into the equation," wrote the researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore and the University of Michigan Medical School in Ann Arbor. "The inclusion of common benign disease might represent the tipping point at which both superior level of care and high volume shift away from teaching hospitals in favor of non-teaching hospital settings. Where teaching hospitals perform surgery in comparatively lower volume, they may also demonstrate comparatively poorer outcomes."
The analysis suggests that both procedure and diagnosis should be taken into account when assessing quality of care and surgical outcomes, the authors wrote, adding that similar data on other procedures may be of interest to patients, payers and healthcare providers as policymakers work to establish quality measures for surgical care.