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A Population Level Analysis: The Influence of Hospital Teaching Status on Management and Outcomes of AAA

Objective: To compare utilization and associated outcomes of endovascular repair of Abdominal Aortic Aneurysms (EVAR) and open surgery (OS) in hospitals with various teaching designations: Major Teaching (MT), Teaching Affiliate (TA), or Non-Teaching (NT).
Methods: Secondary data analysis was performed on the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for New Jersey from 2001 to 2005.
Results: 5,176 patients underwent repair of AAA. The number and percentage of EVAR vs. OS were different at each institution type: MT=1150 (62.6%) vs.688 (37.4%); TA=510 (47.1%) vs.572 (52.9%); NT=732 (32.4%) vs.1524 (67.6%). In univariate analysis, EVAR was found to be performed almost 2 times as often in MT when compared to NT (p<0.0002). In a logistic regression model adjusted for age, race, gender, insurance, and hospital teaching status, MT and TA were significantly associated with increased utilization of EVAR for both elective (OR=3.4; 95%CI: 3.0-3.9 and OR=1.6; 95%CI: 1.4-1.9, respectively) and ruptured AAA (OR=2.7; 95%CI: 1.6-4.7 and OR=2.6; 95%CI: 1.5-4.7, respectively). Mortality for elective EVAR was found to be significantly higher at NT when compared to MT (2.71% vs.0.98%, p=0.0046), but not significantly different between MT and TA (0.98% vs.1.85%, p=0.15). OS mortality was similar at all institution types (MT=5.32%, TA=6.88%, NT=6.33%, p=NS). Logistic regression analysis of the risk factors for AAA mortality found MT significantly improved chances of survival (OR of death=0.76; 95%CI: 0.61-0.95).
Conclusions: Teaching status is an important predictor of the AAA repair method employed and the subsequent hospital mortality. MT hospitals, compared to NT, were significantly more likely to use EVAR and offered a significant improvement in hospital survival.