Consider procedure and diagnosis when choosing facility, researchers advise. Colon surgery patients are more likely to die if their procedure is performed at a teaching hospital, says a new study.

April 21, 2010

U.S. researchers analyzed data from 115,250 patients who underwent colon resection (removal of a part of the colon) for both cancerous and non-cancerous diseases at 1,045 hospitals in 38 states from 2001 through 2005.

The investigators found that fewer patients had their surgery at a teaching hospital (46,656) than at a non-teaching hospital (68,589). Overall, the average length of hospital stay was 10 days, and 4,371 patients (3.8 percent) died in the hospital. Patients in teaching hospitals had half-day longer length of stay and an increased risk of death than those in non-teaching hospitals (3.9 percent versus 3.7 percent, respectively). The study is published in the April issue of the journal Archives of Surgery.

"While the volume-outcome relationship may favor colon cancer resections performed in teaching hospitals, this advantage might be lost when benign colon disease is factored into the equation," wrote the researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore and the University of Michigan Medical School in Ann Arbor. "The inclusion of common benign disease might represent the tipping point at which both superior level of care and high volume shift away from teaching hospitals in favor of non-teaching hospital settings. Where teaching hospitals perform surgery in comparatively lower volume, they may also demonstrate comparatively poorer outcomes."

The researchers said their findings suggest that both procedure and diagnosis should be taken into account when assessing quality of care and surgical outcomes.

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