Teaching Hospital Surgery Deaths Higher in Blacks

Kathleen Blanchard's picture
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The Archives of Surgery reports that survival in surgery patients is better in teaching hospitals compared to non-teaching hospitals. However, the same survival benefit does not hold true for black patients.

Jeffrey H. Silber, M.D., Ph.D., and colleagues from the Center for Outcomes Research at The Children's Hospital of Philadelphia and the University of Pennsylvania authored the study. The group says it isn't clear why patients fare better in teaching hospitals, speculating that the nursing staff and technology may be better, accounting for fewer deaths.

"While teaching hospitals are generally larger and have more advanced technology, greater volume and better nurse staffing (attributes that may aid in both preventing complications and successfully treating complications), it is by no means clear whether all patients benefit equally from these attributes," the authors write.

Following an analysis of Medicare costs of 4,658,954 patients, ages 65 to 90 who underwent orthopedic or vascular surgery, the results showed that patients in teaching hospitals had a fifteen percent lower chance of dying. The same statistic was true for the odds of dying from complications - but not for black patients - even in the same hospital.

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The researchers used data from 3,270 acute care hospitals, adjusting for income variable that might influence access to teaching hospitals.

According to the report, "Unintentional differences in communication might lead to less appropriate or less accurate monitoring of black patients or less involvement in their care by personnel who could make a difference in reducing failure to rescue."

Previous findings show that blacks also experience longer delays in defibrillation compared to whites.

The authors also say another factor leading to higher post-surgery death rates among blacks than whites in teaching hospitals may include variances intern and resident involvement with different racial groups of patients.

http://archsurg.ama-assn.org/cgi/content/full/144/2/113

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