In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 8 ( 2023-8-25), p. e0290734-
Abstract:
The effect of teaching hospital status on cardiovascular surgery has been of common interest in recent decades, yet its magnitude on heart valve replacement is still a matter of debate. Given the ethical and practical unfeasibility of randomly assigning a patient to such an exposure, we use the inverse probability of treatment weighting (IPTW) to assess this marginal effect on the survival of Colombian patients who underwent a first heart valve replacement between 2016 and 2019. Methods A retrospective cohort study was conducted based on administrative records. The time-to-death event and cumulative incidences of death, readmission, and reoperation are presented as outcomes. An artificial sample is configured through IPTW, adjusting for sociodemographic variables, comorbidities, technique, and intervention weight. Results Of a sample of 3,517 patients, 1,051 (29.9%) were operated on in a teaching hospital. The median age was 65.0 (18.1–91.5), 38.5% of patients were ≤60, and 6.9% were ≥80. The cumulative incidences of death at 30, 90 days, and one year were 5.9%, 8%, and 10.9%, respectively. Furthermore, 23.5% of the patients were readmitted within 90 days and 3.6% underwent reintervention within one year. The odds of 30-day mortality are lower for patients operated in a teaching hospital (OR 0.51; 95% CI 0.29–0.92); however, no effect on survival was identified in terms of time-to-event of death (HR 1.07; 95%CI 0.78–1.46). Conclusions After IPTW, the odds of 30-day mortality are lower for patients operated in a teaching hospital. There was no effect on survival, 90-day or one-year mortality, 90-day readmission, or one-year reintervention. Together, we offer an opening for investigating an exposure that has yet to be explored in Latin America with potential value to understand teaching hospitals as the essential nature of reality of an academic-clinical synergy.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0290734
DOI:
10.1371/journal.pone.0290734.g001
DOI:
10.1371/journal.pone.0290734.t001
DOI:
10.1371/journal.pone.0290734.t002
DOI:
10.1371/journal.pone.0290734.t003
DOI:
10.1371/journal.pone.0290734.s001
DOI:
10.1371/journal.pone.0290734.s002
DOI:
10.1371/journal.pone.0290734.s003
DOI:
10.1371/journal.pone.0290734.s004
DOI:
10.1371/journal.pone.0290734.s005
DOI:
10.1371/journal.pone.0290734.s006
DOI:
10.1371/journal.pone.0290734.s007
DOI:
10.1371/journal.pone.0290734.s008
DOI:
10.1371/journal.pone.0290734.r001
DOI:
10.1371/journal.pone.0290734.r002
DOI:
10.1371/journal.pone.0290734.r003
DOI:
10.1371/journal.pone.0290734.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
Bookmarklink