The Hospital Matters: Association Between Hospital Teaching Status and Patient Outcomes in Emergency General Surgery

Variations in outcomes following emergency general surgery (EGS) are often attributed to patient factors. However, system-level variables may also play a role. This study aimed to evaluate the association between hospital teaching status and patient outcomes in EGS.

We retrospectively analyzed the 2019 Nationwide Readmissions Database to identify patients ≥18 y undergoing EGS procedures. Hospitals were stratified into teaching hospitals (THs) and nonteaching hospitals (NTHs). Multivariable logistic regression was used to study the impact of hospital teaching status on patient in-hospital mortality and postoperative complications. Sensitivity analyses were performed to examine the same relationship in each EGS procedure.

A total of 237,044 patients were included: 179,472 (76%) in TH and 57,572 (24%) in NTH. On univariate analysis, TH had a higher volume of EGS admissions (fourth volume quartile 33% versus 8%, P < 0.001). After adjusting for clinically relevant factors, patients at TH had a 15% lower risk of composite complications (adjusted odds ratio [aOR]: 0.85,confidence interval [CI]: 0.83-0.88), driven by lower risk of infectious (aOR: 0.87, CI: 0.83-0.92), cardio-respiratory (aOR: 0.85, CI: 0.82-0.89), and renal (aOR: 0.88, CI: 0.86-0.91) complications, but they were at increased risk of in-hospital mortality (aOR: 1.11, CI: 1.02-1.21) and 30-d readmission (aOR: 1.11, 95% CI: 1.08-1.14). Sensitivity analyses showed consistently lower risk of composite complications but no differences in mortality or readmission in TH compared to NTH in each EGS procedure.

Teaching hospitals are independently associated with lower risk of postoperative complications but increased mortality and readmissions in EGS patients. These findings highlight the importance of investigating the impact of system-level variables on patient outcomes to identify novel targets for performance improvement.