Racial gap found in saving patients after surgical complications

White patients have better survival rates at teaching hospitals, even after adjusting for income.

By Kevin B. O’Reilly — Posted March 5, 2009

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Teaching hospitals outperform other hospitals at saving patients who experience deadly surgical complications, but only if those patients are white.

That's the finding of a study in the February Archives of Surgery that analyzed Medicare claims from 4.6 million patients at 3,270 acute care hospitals from 2000 to 2005. Patients at teaching and nonteaching hospitals experienced similar rates of surgical complications, but white patients at teaching hospitals were 17% less likely to die afterward.

Black patients had similar survival rates after surgical complications whether at teaching or nonteaching hospitals, even after adjusting for income.

The study seemed to contradict previous studies on the source of racial disparities. The new study is available online (link).

For example, a June 25, 2007, Archives of Internal Medicine study examined how 123 teaching hospitals scored on Hospital Quality Alliance measures in caring for more than 320,000 patients. The researchers found that racial and ethnic disparities were vastly reduced or even eliminated after adjusting for where minority patients were treated.

"It would be an easier story to tell the public if we just could say that blacks are going to the wrong hospitals, but that's not what this story says," said Archives of Surgery study lead author Jeffrey H. Silber, MD, PhD, director of the Center for Outcomes Research at The Children's Hospital of Philadelphia. "There is something going on within the hospitals themselves that's showing the disparity."

Dr. Silber, who is professor of pediatrics and anesthesia at the University of Pennsylvania School of Medicine, developed the failure-to-rescue quality measure in the early 1990s to gauge how well hospitals do at saving patients who experience surgical complications.

Many quality comparisons are hobbled because some hospitals' mortality outcomes may depend less on the care they provide than how sick their patients are. But comparing only patients who experience complications allows for a more apples-to-apples quality test, Dr. Silber said.

The study could not answer what teaching hospital factors contributed to the lower mortality rates for whites than blacks. Dr. Silber speculated that blacks may be cared for by less experienced physicians or be hurt by hampered doctor-patient communication.

He said a review of individual patient charts would be necessary to pinpoint what caused the disparity.

"We don't have a clear idea right now as to why there is this big difference," Dr. Silber said. "We are just beginning to understand it. Are there differences in communication between the providers and patients, or are differences between the providers themselves? ... We don't have an answer to this puzzle yet."

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