Study Finds Racial Disparity in Surgery Survival Rates

Elderly patients who undergo surgery at teaching-intensivehospitals have better survival rates than at nonteaching hospitals, but thesebetter survival rates occur in white patients, not black patients, according toa study coauthored by a School of Public Health researcher.

"Survival after surgery is higher at hospitals with higherteaching intensity," according to the study, which appears in the February issueof the Archives of Surgery and was coauthored by Amy Rosen, an SPH professor of health policy and management and director of risk assessment andpatient safety at the VA’s Center for Health Quality, Outcomes and EconomicResearch in Bedford, Mass.

"Improved survival is because of lower mortality aftercomplications … and generally not because of fewer complications," the authorssay. "However, this better survival and failure to rescue (rate) atteaching-intensive hospitals is seen for white patients, not for blackpatients."

The research team, led by Jeffrey H. Silber, director ofthe Center for Outcomes Research at Children’s Hospitalof Philadelphia, analyzed Medicareclaims from 4.6 million patients, aged 65 to 90, who were admitted for general,orthopedic, and vascular surgery at 3,270 acute-care hospitals in the United Statesfrom 2000 to 2005. Hospitals were classified as nonteaching hospitals if theyhad no medical residents, and teaching hospitals were scaled by their ratio ofresidents to hospital beds.

The researchers measured mortality 30 days after surgery,in-hospital complications, and failure-to-rescue, defined as the probability ofdeath following complications. They found that compared to nonteachinghospitals, hospitals with the highest ratio of residents to beds had 15 percentlower mortality after surgery, no difference in complications, and 15 percentlower odds of death after complications (failure-to-rescue).

However, these benefits were observed in white patients, notblack patients. Unlike whites, for black patients, the odds of death,complications, and failure-to-rescue were similar at both teaching andnonteaching hospitals. The associations were adjusted for patient illness onadmission; adjusting for income level did not change the results.

Black patients displayed higher complication rates thanwhite patients at both teaching and nonteaching hospitals, although there wasno difference in complication rates between teaching and nonteaching hospitalsfor black or white patients. While white patients at teaching hospitalsexperienced better survival rates after complications than black patients whencompared to nonteaching hospitals, black patients experienced the samesurvival after complications at both types of hospitals.

The researchers found this racial disparity existed not onlyacross different hospitals, but also for white and black patients within thesame hospitals.

"Why racial differences in failure-to-rescue should occurwithin hospitals is not well understood, but there are many possibilities," theauthors write. They offered as a possible explanation unintentional differencesin communication between patients and providers. Also, in previous work, Silberand his colleagues found that surgical procedures take longer for black patientsthan white patients in some hospitals.

Funding for the study came from the National Heart, Lung,and Blood Institute of the National Institutes of Health, the U.S. Departmentof Veterans Affairs, and the National Science Foundation.

Read the full study online.