Time of year does not influence mortality for vascular operations at academic centers

Abstract

Objective: Studies in general surgery have suggested worse outcomes due to the presence of new trainees. We hypothesized that outcomes for vascular operations would be equal regardless of teaching hospital status or academic quarter within the United States.

Methods: From 2003 to 2007, 264,374 vascular operations were evaluated using the Nationwide Inpatient Sample database. Patients were stratified according to Non-Teaching (non-Teaching Hospital [NTH], n = 137,406), Teaching (Teaching Hospital [TH], n = 126,968), and Teaching with Vascular Surgery Training Program (VSH, n = 28,730) hospital status. Multivariate analyses were used to examine the effect of academic quarter (AQ) on mortality.

Results: Unadjusted mortality was higher at TH compared with NTH (2.5% vs 2.0%; P < .001). Aortic and peripheral vascular operations were more common at TH, while carotid endarterectomy (P < .001) was more frequent at NTH (P < .001). After risk adjustment, the odds of death were significantly (P < .001) increased for aortic and peripheral vascular operations but were similar at both TH (1.11 [0.98-1.25]; P = .10) and VSH (1.16 [0.98-1.37]; P = .08) compared with NTH. Importantly, AQ was not associated with increased risk of mortality at either TH (AQ1 odds ratios [OR] = 0.95 [080-1.13], AQ2 OR = 1.08 [0.91-1.28], AQ3 OR = 1.13 [0.96-1.34], AQ4 = Reference; P = .19) or VSH (AQ1 OR = 1.02 [0.81-1.29], AQ2 OR = 0.99 [0.79-1.25], AQ3 OR = 1.02 [0.81-1.28], AQ4 = Reference; P = .99).

Conclusions: Mortality is not significantly influenced by operative time of year following vascular operations at academic centers. TH perform more high-risk operations compared with NTH with similar risk adjusted mortality.