Lung surgery risks lower at teaching hospitals

People undergoing surgery for lung cancer tend to fare better when the procedure is done at a teaching hospital, a new study suggests.
Using government data on more than 3,200 U.S. hospitals, researchers found that patients having lung cancer surgery at a teaching hospital were 17 percent less likely to die shortly thereafter compared with patients at non-teaching hospitals.
Teaching hospitals are the training ground for residents and medical students, and are usually affiliated with a nearby medical school. Some patients worry that the quality of care at these centers is lower because they rely partially on such doctors-in-training.
"There's a public perception that teaching hospitals can be dangerous places because of training issues, and concerns are frequently voiced by patients and echoed in the press regarding a fear of physicians-in- training practicing on them," Dr. Robert Meguid, the lead researcher on the new study, said in a statement.
"The data from our study help refute these fears," said Meguid, a surgical resident at Johns Hopkins University School of Medicine in Baltimore.
For the study, which is published in the Annals of Thoracic Surgery, Meguid and his colleagues looked at patient records from a government database that maintains discharge information from about 20 percent of U.S. hospitals.
They found that among 46,951 patients who had lung cancer removed between 1998 and 2004, 3.5 percent died in the hospital. The risk was 17 percent lower in teaching hospitals when other factors -- such as the number of procedures performed at the hospital -- were weighed.
Past studies have shown that surgery outcomes are typically better at hospitals that do a large number of the operations. "This is the first study we know of which shows that teaching hospitals are factors associated with good patient outcome, independent of volume," Meguid said.
Patients may fare better at teaching hospitals because they often have more intensive care units dedicated to surgery, run by intensive care specialists, according to Meguid and his colleagues.
They add that teaching hospitals may have "specialty services," such as round-the-clock respiratory therapy, and typically have more manpower -- with residents, medical students, nurse practitioners and physician assistants continuously on-site.
This larger staff may help reduce the risk of post-surgery complications.
More research is needed to pinpoint the "processes of care" related to better lung cancer surgery outcomes, according to Meguid's team, so that care can be improved at all hospitals.
SOURCE: Annals of Thoracic Surgery, March 2008.