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. 2009 Aug;50(2):243-50.
doi: 10.1016/j.jvs.2009.01.046. Epub 2009 May 15.

Impact of hospital teaching status on survival from ruptured abdominal aortic aneurysm repair

Robert A Meguid  1 , Benjamin S Brooke, Bruce A Perler, Julie A Freischlag
Affiliations

Impact of hospital teaching status on survival from ruptured abdominal aortic aneurysm repair

Robert A Meguid et al. J Vasc Surg. 2009 Aug.

Abstract

Objectives: Controversy exists over the optimal hospital type to which high-risk surgical patients should be referred for operative management. While high volume centers have been traditionally advocated, recent evidence suggests teaching hospitals may have better outcomes for high-risk patients. We investigated whether mortality outcomes of patients undergoing surgery for ruptured abdominal aortic aneurysm (rAAA) were different between teaching hospitals and non-teaching hospitals, independent of hospital operative volume.

Methods: A retrospective review of the Nationwide Inpatient Sample dataset (1998-2004) was performed to identify open and endovascular (EVAR) repair for rAAA. Hospitals were stratified by teaching status, including teaching hospitals (TH) with any type of residency training program, those with general surgery training programs (GSTH) and those with vascular surgery training programs (VSTH). The association of hospital teaching status with in-hospital mortality for open AAA repair and EVAR was assessed via multi-level multivariable logistic regression, controlling for patient demographics, comorbidities, and hospital operative volume.

Results: Of 6636 open AAA repairs for rAAA, the overall perioperative mortality was 42%. Mortality was significantly lower at TH than non-TH (39.3% vs 44.5%; P < .05). Mortality was also lower at GSTH (38.7%) and VSTH (34.3%). After adjusting for hospital operative volume, patient demographics, and comorbidities, we found a 25% decrease in likelihood of in-hospital death at VSTH vs non-VSTH (odds ratio 0.75; 95% confidence interval 0.60-0.94; P < .05).

Conclusion: In-hospital mortality is significantly reduced for patients undergoing open AAA repair for rAAA at teaching hospitals and hospitals with vascular surgery training programs, independent of volume. These results suggest that in addition to factors associated with teaching hospitals in general, the type of specialty training within teaching institutions is a critical factor which may influence outcomes, specifically for patients with rAAA.

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Figures

Figure 1
Figure 1. In-Hospital Mortality Rates for Patients Undergoing Open AAA Repair for rAAA by Hospital Teaching Status
Univariate comparison of mortality rates reveals P<0.001.
Figure 2
Figure 2. Adjusted Odds Ratio of In-Hospital Mortality for Patients Undergoing Open AAA Repair of rAAA by Hospital Teaching Status
Point estimate with 95% confidence intervals for risk of in-hospital death for patients undergoing open AAA repair for rAAA at each type of teaching hospital as compared to those hospitals lacking that type of hospital teaching status. Multi-level random effects multivariable logistic regression includes hospital teaching status, patient age, sex, race, Charlson index of comorbidities and annual hospital volume of open AAA repair for rAAA.
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