• Jeffrey H Silber, Paul R Rosenbaum, Patrick S Romano, Amy K Rosen, Yanli Wang, Yun Teng, Michael J Halenar, Orit Even-Shoshan, and Kevin G Volpp.
• Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market St, Ste 1029, Philadelphia, PA 19104, USA. silberj@wharton.upenn.edu
• Arch Surg. 2009 Feb 1;144(2):113-20; discussion 121.

ObjectivesTo determine if the lower mortality often observed in teaching-intensive hospitals is because of lower complication rates or lower death rates after complications (failure to rescue) and whether the benefits at these hospitals accrue equally to white and black patients, since black patients receive a disproportionate share of their care at teaching-intensive hospitals.DesignA retrospective study of patient outcomes and teaching intensity using logistic regression models, with and without adjusting for hospital fixed and random effects.SettingThree thousand two hundred seventy acute care hospitals in the United States.PatientsMedicare claims on general, orthopedic, and vascular surgery admissions in the United States for 2000-2005 (N = 4,658,954 unique patients).Main Outcome MeasuresThirty-day mortality, in-hospital complications, and failure to rescue (the probability of death following complications).ResultsCombining all surgeries, compared with nonteaching hospitals, patients at very major teaching hospitals demonstrated a 15% lower odds of death (P < .001), no difference in complications, and a 15% lower odds of death after complications (failure to rescue) (P < .001). These relative benefits associated with higher resident-to-bed ratio were not experienced by black patients, for whom the odds of mortality and failure to rescue were similar at teaching and nonteaching hospitals, a pattern that is significantly different from that of white patients (P < .001).ConclusionsSurvival after surgery is higher at hospitals with higher teaching intensity. Improved survival is because of lower mortality after complications (better failure to rescue) and generally not because of fewer complications. However, this better survival and failure to rescue at teaching-intensive hospitals is seen for white patients, not for black patients.

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