What are the comparative safety outcomes of surgical procedures at private hospitals versus teaching hospitals?

From the Guidelines

Teaching hospitals are generally safer than private hospitals for surgical procedures, particularly for complex surgeries and higher-risk patients, due to their specialized expertise, greater resources, and established protocols for managing complications. This is supported by a study published in the European Urology journal in 2020 1, which found that high-volume hospitals have lower mortality rates and fewer complications for radical cystectomy. The study also noted that surgeon volume is an important factor in determining surgical outcomes, with higher-volume surgeons having better results. Another study published in Chest in 2013 1 found that teaching hospitals have better outcomes for lung cancer surgery, with lower hospital mortality rates and improved long-term survival. The evidence suggests that the advantage of teaching hospitals stems from their ability to manage complex cases and high-risk patients, as well as their greater resources and expertise.

When considering surgery, patients should evaluate the specific procedure needed, the hospital's experience with that procedure, surgeon qualifications, and their own health status rather than focusing solely on whether the facility is private or academic. Key factors to consider include:

• Hospital volume: High-volume hospitals tend to have better outcomes for complex surgeries
• Surgeon volume: Higher-volume surgeons tend to have better results
• Specialized expertise: Teaching hospitals often have more specialized expertise and resources for managing complex cases
• Patient characteristics: Patients with higher-risk profiles may benefit from the specialized care and resources available at teaching hospitals.

Overall, the evidence suggests that teaching hospitals are generally safer than private hospitals for surgical procedures, particularly for complex surgeries and higher-risk patients, due to their specialized expertise, greater resources, and established protocols for managing complications 1.

From the Research

Comparative Safety Outcomes of Surgical Procedures

• The safety outcomes of surgical procedures at private hospitals versus teaching hospitals have been compared in several studies 2, 3, 4, 5, 6.
• A study published in 2002 found that complications are common in hospitalized surgical patients, and provider error contributes to a significant proportion of these complications 2.
• Another study published in 2021 found that the quality of care tends to be higher at major teaching hospitals, with lower short-term mortality rates and higher long-term survival rates for cancer patients 3.
• A study published in 2009 found that patients at very major teaching hospitals demonstrated a 15% lower odds of death and a 15% lower odds of death after complications, compared to patients at nonteaching hospitals 4.
• However, the same study found that these benefits did not accrue equally to black patients, who had similar odds of mortality and failure to rescue at teaching and nonteaching hospitals 4.
• A study published in 2020 found that teaching hospitals had lower rates of inpatient mortality and perioperative complications for brain tumor surgeries, even after controlling for hospital case volume 5.
• Another study published in 2008 found an inconsistent relationship between teaching status and postoperative patient safety event rates, with major teaching hospitals having higher odds of some complications and lower odds of others 6.

Factors Influencing Safety Outcomes

• Hospital teaching status is associated with various hospital and patient characteristics, which can mediate the relationship between teaching status and safety outcomes 6.
• The volume of surgical procedures performed at a hospital can also influence safety outcomes, with higher volume hospitals tend to have better outcomes 5.
• The quality of care provided by hospitals can vary depending on factors such as staffing variables, patient case mix, and other risk factors 6.

Implications for Patient Care

• The findings of these studies suggest that teaching hospitals may have an advantage in terms of safety outcomes for certain types of surgical procedures 3, 5.
• However, the benefits of teaching hospitals may not accrue equally to all patients, and further research is needed to understand the factors that influence safety outcomes 4.
• Patients and healthcare providers should be aware of the potential differences in safety outcomes between teaching and private hospitals, and make informed decisions about where to receive care 2, 3, 4, 5, 6.