Aggressive Treatment Style and Surgical Outcomes

Authors

  • Jeffrey H. Silber,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104
    2. Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Pennsylvania, PA
    3. Department of Health Care Management, The Wharton School, The University of Pennsylvania, Pennsylvania, PA
    4. Leonard Davis Institute of Health Economics, The University of Pennsylvania, Pennsylvania, PA
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    • Address correspondence to Jeffrey H. Silber, M.D., Ph.D., Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104; e-mail: silberj@wharton.upenn.edu. Jeffrey H. Silber, M.D., Ph.D., is with the Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Pennsylvania, PA. Jeffrey H. Silber, M.D., Ph.D., is also with the Department of Health Care Management, The Wharton School, The University of Pennsylvania, Pennsylvania, PA. Jeffrey H. Silber, M.D., Ph.D., and Orit Even-Shoshan, M.S., are with the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Pennsylvania, PA. Robert Kaestner, Ph.D., is with the Department of Economics, Institute of Government and Public Affairs, The University of Illinois, Chicago, IL. Orit Even-Shoshan, M.S., Yanli Wang, M.S., and Laura J. Bressler, B.A., are with the Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.

  • Robert Kaestner,

    1. Department of Economics, Institute of Government and Public Affairs, The University of Illinois, Chicago, IL
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  • Orit Even-Shoshan,

    1. Leonard Davis Institute of Health Economics, The University of Pennsylvania, Pennsylvania, PA
    2. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Yanli Wang,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Laura J. Bressler

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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Abstract

Objective. Aggressive treatment style, as defined by the Dartmouth Atlas of Health Care, has been implicated as an important factor contributing to excessively high medical expenditures. We aimed to determine the association between aggressive treatment style and surgical outcomes.

Data Sources/Study Setting. Medicare admissions to 3,065 hospitals for general, orthopedic, and vascular surgery between 2000 and 2005 (N=4,558,215 unique patients).

Study Design. A retrospective cohort analysis.

Results. For elderly surgical patients, aggressive treatment style was not associated with significantly increased complications, but it was associated with significantly reduced odds of mortality and failure-to-rescue. The odds ratio for complications in hospitals at the 75th percentile of aggressive treatment style compared with those at the 25th percentile (a U.S.$10,000 difference) was 1.01 (1.00–1.02), p<.066; whereas the odds of mortality was 0.94 (0.93–0.95), p<.0001; and for failure-to-rescue it was 0.93 (0.92–0.94), p<.0001. Analyses that used alternative measures of aggressiveness—hospital days and ICU days—yielded similar results, as did analyses using only low-variation procedures.

Conclusions. Attempting to reduce aggressive care that is not cost effective is a laudable goal, but policy makers should be aware that there may be improved outcomes associated with patients undergoing surgery in hospitals with a more aggressive treatment style.

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