• Justin B Dimick, John A Cowan, Lisa M Colletti, and Gilbert R Upchurch.
• Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA. jdimick@umich.edu
• Arch Surg Chicago. 2004 Feb 1;139(2):137-41.

HypothesisComplex operations performed in teaching hospitals have similar outcomes as those performed in nonteaching hospitals.DesignObservational cohort study with clinical patient data obtained from the Nationwide Inpatient Sample. The Nationwide Inpatient Sample data were linked to the American Hospital Association hospital survey data for 1997 to determine hospital characteristics. Hospitals were considered high volume if they performed more than the median (50th percentile) number of procedures per year.SettingNationally representative sample of hospitals during 1996 and 1997.PatientsIndividuals undergoing esophageal resection (n = 1247), hepatic resection (n = 2073), or pancreatic resection (n = 3337) in Nationwide Inpatient Sample hospitals during 1996 and 1997 were included.Main Outcomes MeasuresUnadjusted and adjusted in-hospital mortality and prolonged length of stay (>75th percentile).ResultsNone of the procedures had higher operative mortality rates at teaching hospitals. In unadjusted analyses, pancreatic resection (4.0% vs 8.8%; P<.001), hepatic resection (5.3% vs 8.0%; P =.03), and esophageal resection (7.7% vs 10.2%; P =.10) had lower operative mortality rates at teaching compared with nonteaching hospitals. However, after adjusting for hospital volume in the multivariate analysis, hospital teaching status was no longer a predictor of operative mortality.ConclusionsTeaching hospitals have lower operative mortality rates for complex surgical procedures. However, the lower mortality rates at teaching hospitals can be explained by higher procedural volume.

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