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Aggressive Treatment Style and Surgical Outcomes

Dartmouth Atlas; aggressive treatment style; Medicare; mortality; complications; failure-to-rescue

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="whereas" the="the" odds="odds" mortality="mortality" 0.94="0.94" (0.93–0.95),="(0.93–0.95)," p<.0001;="p<.0001;" for="for" failure-to-rescue="failure-to-rescue" it="it" was="was" 0.93="0.93" (0.92–0.94),="(0.92–0.94)," p<.0001.="p<.0001." that="that" used="used" alternative="alternative" measures="measures" of="of" aggressiveness—hospital="aggressiveness—hospital" days="days" and="and" icu="icu" days—yielded="days—yielded" similar="similar" results,="results," as="as" did="did" analyses="analyses" using="using" only="only" low-variation="low-variation" procedures.</p="procedures.</p">

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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