Mortality in medicare patients undergoing surgery in July in teaching hospitals
Michael J Englesbe1, Zhaohui Fan, Onur Baser
1Department of Surgery, Michigan Surgical Collaborative for Outcomes Research and Evaluation, University of Michigan, Ann Arbor, Michigan 48109-0331, USA. englesbe@med.umich.edu
Objective:
To determine whether operative mortality rates at teaching hospitals in the United States are higher in July, the start of the academic year.
Summary Background Data:
Surgical patients at teaching hospitals often worry about the involvement of inexperienced physician trainees in their care.
Methods:
This retrospective cohort study included all Medicare recipients undergoing 1 of 7 diverse inpatient procedures at teaching hospitals between 2003 through 2006 (N = 320,216). Teaching status was defined both by membership in the United States Council of Teaching Hospitals and by hospital ratio of trainees to beds. We compared operative mortality rates in July relative to all other months, adjusting for potentially confounding patient characteristics. The main outcome measure was operative mortality (before discharge or within 30 days of procedures).
Results:
Adjusted operative mortality rates were no higher in July than in other months combined for all procedures, including coronary artery bypass grafting, carotid endarterectomy, repair of nonruptured abdominal aortic aneurysms, colectomy, pancreatectomy, esophagectomy, and repair of hip fracture. Trend analysis revealed no significant monthly or seasonal variation in operative mortality rates.
Conclusions:
Operative mortality rates do not decline as surgical trainees acquire more experience during the academic year. With respect to mortality, July is a safe month to have major surgery in teaching hospitals in the United States.
Insights
July is a safe month for major surgery in U.S. teaching hospitals. Operative mortality rates for Medicare recipients were not higher in July compared to other months, even with new surgical trainees.
Area of Science:
- Medical research
- Surgical outcomes
- Healthcare quality
Background:
- Patients at teaching hospitals express concern regarding the involvement of new medical trainees in their surgical care.
- The start of the academic year in July may coincide with increased numbers of less experienced surgical staff.
Purpose of the Study:
- To investigate if operative mortality rates are elevated in July at U.S. teaching hospitals.
- To assess the impact of the academic calendar on surgical patient safety.
Main Methods:
- Retrospective cohort study of 320,216 Medicare recipients undergoing 7 diverse inpatient procedures at teaching hospitals (2003-2006).
- Teaching hospital status determined by council membership and trainee-to-bed ratio.
- Comparison of operative mortality rates in July versus other months, with adjustments for patient characteristics.
Main Results:
- No statistically significant difference in adjusted operative mortality rates was observed in July compared to other months.
- This finding held true across various procedures, including coronary artery bypass grafting and hip fracture repair.
- Analysis showed no significant monthly or seasonal variations in operative mortality.
Conclusions:
- Operative mortality rates do not appear to be higher in July at U.S. teaching hospitals.
- Surgical trainees' increasing experience throughout the academic year does not correlate with declining mortality rates.
- July is a safe month for patients undergoing major surgery in teaching hospitals.
