Do postoperative complications vary by hospital teaching status?

Abstract

Objective: The purpose of this paper is to assess postoperative patient safety outcomes across teaching and nonteaching hospitals and to examine the relation of hospital and patient factors to patient safety outcomes. RESEARCH DESIGN AND Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. Patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ) were used to identify 6 postoperative PSIs. The study sample consisted of 646 acute care hospitals, divided into nonteaching (n ≤ 400), minor teaching (n ≤ 207), and major teaching hospitals (n ≤ 39). The unit of analysis was the patient. Associations between hospital teaching status and patient and hospital characteristics were determined using one-way analysis of variance and Pearson ‡ test. Multivariable analysis using generalized estimating equation regression models assessed the relationship between teaching status and PSIs. Results: Bivariate results showed higher observed PSI rates at major teaching hospitals. Results from multivariable analyses, after adjusting for hospital size, staffing variables, patient case mix, and other risk factors, showed that major teaching hospitals had significantly higher odds of postoperative pulmonary embolism or deep vein thrombosis and postoperative sepsis, lower odds of postoperative respiratory failure, and showed no difference for postoperative hip fracture, postoperative hematoma or hemorrhage, and postoperative physio-metabolic derangement. Conclusions: The present analysis found an inconsistent relationship between teaching status and postoperative patient safety event rates. Teaching status of the hospital was associated with numerous hospital and patient characteristics which mediate the relationship between teaching status and PSIs. © 2007 by Lippincott Williams and Wilkins.