A multi-institutional comparison of pediatric appendicitis outcomes between teaching and nonteaching hospitals.

摘要

OBJECTIVE: In this era of heightened emphasis on patient outcomes, it is important to document the effect of residents acting as the surgeon for a surgical procedure. This study compares the outcomes of appendicitis between teaching and nonteaching institutions. DESIGN: A retrospective review from 1998 to 2007 was performed. The study outcomes were postoperative morbidity and length of hospitalization (LOH). Data were analyzed using Wilcoxon rank-sum test and chi(2) analysis. SETTING: Two teaching institutions (each with its own General Surgery residency program) were compared with 10 nonteaching institutions. RESULTS: A total of 1472 patients were treated at the teaching institutions (mean age = 9.8 years, male = 63%), and 6431 patients were treated at the nonteaching institutions (mean age = 10.8 years, male = 62%). The perforated appendicitis rate was 37% at the teaching institutions and 30% at the nonteaching institutions (p < 0.0001). For nonperforated appendicitis, a higher rate of laparoscopic appendectomy was found at the nonteaching institutions versus the teaching institutions (39% vs 52%, p < 0.0001). Otherwise, no difference was noted in the rate of wound infection, postoperative abscess drainage, or readmissions between the institutions. The LOH was also similar. For perforated appendicitis, a lower wound infection (5.2% vs 8.2%, p = 0.03) and readmission (5.6% vs 9.7%, p = 0.004) rate was found at the teaching institutions. No differences were discovered in the incidence of postoperative abscess drainage or LOH between teaching versus nonteaching hospitals. Perforated appendicitis was managed nonoperatively more commonly at the teaching institutions (7.4% vs 12.8%, p = 0.0001). CONCLUSIONS: Postoperative morbidity was similar in children with nonperforated appendicitis and lower in children with perforated appendicitis at teaching institutions. LOH was similar between teaching and nonteaching institutions. Overall, the presence of surgical trainees had no adverse impact on the quality of care for children with appendicitis.