The effect of hospital teaching status on adverse outcomes among breast cancer patients receiving radiotherapy and brachytherapy

Radiotherapy and brachytherapy are integral treatments for breast cancer, yet the influence of hospital characteristics on patient outcomes remains underexplored. This study evaluated the influence of hospital teaching status (teaching vs non-teaching) on radiation-related complications, in-hospital mortality, readmission rate and healthcare resource utilization (HCRU) in breast cancer patients receiving these therapies. We conducted a retrospective cohort study using the US Nationwide Readmissions Database (2016-2021), including female breast cancer patients aged ≥18 years who underwent radiotherapy or brachytherapy. Multivariable logistic regression models evaluated the impact of hospital teaching status (teaching vs non-teaching) on clinical outcomes. Among 9030 patients, 7177 (79.5%) were treated at teaching hospitals. These patients were younger, had a higher prevalence of metastatic disease, and were less likely to undergo breast-conserving surgery or mastectomy. In-hospital mortality was higher for radiotherapy than for brachytherapy (4.2% vs 0.3%), with no unadjusted difference by hospital type. Radiation-related complications were more frequent in non-teaching hospitals for both radiotherapy (OR: 1.11 [1.01, 1.21]). Radiotherapy readmission rates were lower at non-teaching hospitals at 30 (OR: 0.82 [0.70, 0.95]) and 90 days (OR: 0.84 [0.74, 0.95]), with reduced costs and shorter length of stay compared to patients receiving radiotherapy at teaching hospitals. Our study demonstrates that breast cancer patients undergoing radiotherapy at non-teaching hospitals experienced better prognosis, with lower readmission rates, reduced healthcare costs, and shorter lengths of stay compared to those treated at teaching hospitals. These findings highlight important differences in patient outcomes and healthcare resource utilization between teaching and non-teaching hospitals, emphasizing the need for further research to understand the underlying causes and optimize care delivery.