VOLUME 45 | NUMBER 6.2 | DECEMBER 2010
Response to Commentaries on Silber et al.: Aggressive Treatment Styles and Surgical Outcomes
Common themes discussed by Barnato, and Fisher and Skinner concerned the use of 30-day versus 365-day mortality and the effect size associated with aggressiveness. We believe it is appropriate to focus on results from the analysis of 30-day mortality and not 365-day mortality, as do Barnato, and Fisher and Skinner when they interpret our findings. An important reason for our preference is that the 30-day window is most closely aligned to the research question of interest, which is to assess how differences in hospital treatment styles, as measured by Dartmouth end-of-life measures, affect surgical quality (see equation 2 in our paper [Silber et al. 2010]). Examining a period beyond 30 days increases the likelihood that the association between aggressiveness and surgical outcomes will be confounded by effects on survival of treatment by other providers.
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