Hospital teaching status and patient outcomes in intestinal obstruction surgery: A comparative analysis
Fidelis Uwumiro1
, Oluwatobi Olaomi2, Victory Okpujie1, Chimaobi Nwevo3, Uwakmfonabasi Abel Umoudoh4, Grace Ogunkoya5, Olawale Abesin6, Michael Bojeranu7, Bolanle Aderehinwo5, Olasunkanmi Oriloye8
1Department of General Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
2Department of General Surgery, University of Ibadan College of Medicine, Ibadan, Nigeria
3Department of General Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
4Department of Surgery, Southport and Formby District Hospital, Southport Merseyside, United Kingdom
5Department of General Surgery, Lagos State University Faculty of Medicine, Lagos, Nigeria
6Department of Surgery, Royal Cornwall Hospital (Treliske), Truro, Cornwall, United Kingdom
7Department of Surgery, St. Barnabas Hospital SBH Health System, Bronx, New York, United States
8 Deparment of Surgery, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
Abstract
Objective: Surgery at large teaching hospitals is reportedly associated with more favourable outcomes. However, these results are not uniformly consistent across all surgical patients. This study aimed to assess potential disparities in clinical outcomes by hospital type for patients with intestinal obstruction.
Material and Methods: 2018 NIS was queried for all adult non-elective admissions for intestinal obstruction. Hospitals were classified as either smallmedium non-teaching hospitals or large teaching hospitals. Multivariate regression analyses were used to assess the association between hospital type and inpatient mortality, access to surgery, admission duration, non-home discharges, hospital costs, and postoperative complications.
Results: After adjustments, admission to large teaching hospitals was not associated with a reduction in inpatient mortality (AOR= 0.73; 95% CI= 0.41- 1.31; p= 0.29), lower likelihood of surgery (AOR= 0.93; 95% CI= 0.58-1.48; p= 0.76) or increased chance of early surgery (p= 0.97). Patients admitted to large teaching hospitals had shorter hospital stays (p= 0.002) and were less likely to be discharged to other acute care hospitals (AOR= 0.94; 95% CI= 0.80-0.94; p= 0.04). Admission to large teaching hospitals was not associated with a reduction in perioperative complications (AOR= 1.04; 95% CI= 0.80- 1.28; p= 0.91) or significantly higher hospital costs (mean increase= 1518; 95% CI= 1891-4927; p= 0.38).
Conclusion: Admission to large teaching hospitals does not necessarily result in better patient outcomes. Merely considering the teaching status of the hospital in isolation cannot explain the diverse outcomes observed for this condition.
Keywords: Intestinal obstruction, hospital teaching status, inflammatory bowel diseases, bands and adhesions
Cite this article as: Uwumiro F, Olaomi O, Okpujie V, Nwevo C, Umoudoh UA, Ogunkoya G, et al. Hospital teaching status and patient outcomes in intestinal obstruction surgery: A comparative analysis. Turk J Surg 2023; 39 (3): 204-212.
This study was approved by JOS University Teaching Hospital Institutional Health Research Ethical Committee (Decision no: JUTH/DCS/ADM/127/XIX/5111, Date: 08.03.2023).
Externally peer-reviewed.
Concept - FU, OO, VO, BA; Design - FU, VO, CN, GO; Supervision - FU, OA; Fundings - FU, VO, MB, CN; Materials - UAU, OO; Data Collection and/ or Processing - FU, OO, MB; Analysis and/or Interpretation - FU, OO, OA, BA; Literature Search - VO, OA; Writing Manuscript - FU, GO, UAU, MB; Critical Reviews - All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.