Teaching Hospitals' Post-Op Gains Not Extended to Blacks
MONDAY Feb. 16, 2009 -- White patients are less likely to die of post-surgery complications at teaching hospitals than at non-teaching hospitals, but that benefit doesn't apply to black patients, a U.S. study. finds.
A team at the Center for Outcomes Research at The Children's Hospital of Philadelphia and the University of Pennsylvania analyzed data on more than four million Medicare patients, ages 65 to 90, who had general, orthopedic or vascular surgery at 3,270 U.S. hospitals between 2000 and 2005.
Among all hospitals and all surgical procedures combined, the overall death rate in the 30 days after surgery was just over 4.2 percent, the complication rate was about 43.4 percent, and the death rate after complications was 9.75 percent.
"Combining all surgeries, compared with non-teaching hospitals, patients at very major teaching hospitals demonstrated a 15 percent lower odds of death, no difference in complications and a 15 percent lower odds of death after complications," the researchers wrote.
However, black patients had similar odds of death, complication and death after complications at teaching and non-teaching hospitals. This was true even when the researchers compared white and black patients inside the same hospital.
There may be a number of reasons for this disparity, the researchers said. For example, a previous study found that it took longer for black patients to receive heart defibrillation, which suggests potential differences in patient monitoring.
"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" rates of death after complications.
There may also be varying levels of involvement by physicians-in-training in the care of patients in different racial groups, the researchers suggested.
The study was published in the February issue of the journal Archives of Surgery.
The U.S. Agency for Healthcare Research and Quality has more about surgery.
Posted: February 2009
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