Impact of Hospital Teaching Status on Outcomes of Acute Cholangitis: A Propensity-Matched Analysis of Hospitalizations in the United States
Bibliographic record
Abstract
Background: Acute cholangitis (AC) is a serious condition caused by partial or complete obstruction of the common bile duct (CBD), leading to biliary tract infection. We aimed to evaluate whether teaching hospitals with trainees and non-teaching hospitals impact the outcome of AC in the United States. Methods: -tests was performed using SAS 9.4 software to analyze inpatient AC-associated mortality, inflation-adjusted total hospitalization costs (THC), and length of stay (LOS) in US teaching and non-teaching hospitals during the study period. Results: This study included a total of 30,300 patients, out of whom 23,535 (about 78%) were managed in teaching hospitals and 6,765 (about 22%) were managed in non-teaching hospitals. Primary outcomes showed a significant increase in mortality for patients managed in teaching hospitals (2.77% vs. 2.08%, P = 0.01) in comparison to non-teaching hospitals, hospital LOS was slightly higher in teaching hospitals (5 days (interquartile range (IQR): 3 - 6) vs. 4 days (IQR: 3 - 8)) and so did hospital cost ($15,259 vs. $14,506) in comparison to non-teaching hospitals. Secondary outcomes showed that patients in teaching hospitals had higher incidence of septic shock (16.06% vs. 12.53%, P < 0.0001), intensive care unit (ICU) admissions (6.61% vs. 5.07%, P = 0.0002), and intubation (5.30% vs. 3.46%, P < 0.0001) in comparison to non-teaching hospitals. Conclusion: Our study found higher mortality rates for AC patients in teaching hospitals compared to non-teaching hospitals. Teaching hospitals also had higher rates of septic shock, ICU admission, and intubation, with no difference in endoscopic retrograde cholangiopancreatography (ERCP) use. These differences could be due to several factors, such as greater resident and fellow autonomy in teaching hospitals and a potentially more proactive approach by physicians in non-teaching hospitals. Additionally, teaching hospitals often manage more complex, higher-acuity cases, which could contribute to worse outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".