Postoperative adverse events in teaching and nonteaching hospitals

With the recent attention on quality of care and residency training, teaching hospitals are coming under greater scrutiny. Despite several studies, there is still no consensus on whether teaching hospitals deliver higher quality of care than nonteaching hospitals.

This was a retrospective cross-sectional study, using national hospital data. The sample consisted of 3,818 acute care hospitals in the National Inpatient Sample from 1990-1996. The quality indicators were postoperative adverse events, including venous thrombosis/pulmonary embolism (DVT/PE), pulmonary compromise, pneumonia, and urinary tract infection (UTI). Hospitals were classified as major teaching, other teaching, and nonteaching. Quality indicator rates of hospital types were compared and multivariate regression performed to control for specific hospital characteristics.

Teaching hospitals had higher rates of postoperative DVT/PE and pulmonary compromise but lower rates of UTI, compared with nonteaching hospitals. In the multivariate analysis, teaching hospitals were more likely to have higher postoperative DVT/PE rates, and other teaching hospitals had higher rates of pulmonary compromise and UTI. Postoperative pneumonia rates were higher in major teaching hospitals than nonteaching hospitals.

Rates of postoperative adverse events were higher in teaching hospitals compared to nonteaching hospitals. These findings suggest that quality of care, as measured by postoperative adverse events, may not be higher in teaching hospitals.