Hospitals with aggressive treatment styles, also known as high hospital care intensity (HCI), had lower rates of patients dying from a major complication, but longer hospitalizations, according to a study led by the University of Michigan Health System.
The study, published in JAMA Surgery sheds light on failure-to-rescue rates, an indicator of how well hospitals recognize and manage post-surgery complications. Low rates suggest patients are less likely to die.
Patients who had surgery at high HCI vs. low HCI hospitals had increased major complication rates. However, patients who had surgery at high HCI hospitals were 5 percent less likely to die of a major complication (failure to rescue) than at a low HCI facility.
Treatment at high HCI hospitals also meant longer hospitalizations, more inpatient deaths and lower hospice use during the final two years of life.
The research was led by senior author Amir Ghaferi, M.D., assistant professor of surgery at the University of Michigan, and surgical resident Kyle Sheetz, M.D., M.S., both of the U-M’s Center for Healthcare Outcomes and Policy. Ghaferi, chief of general surgery at VA Ann Arbor Healthcare, is also a member of the U-M Institute for Healthcare Policy & Innovation.
“These data have significant implications for surgeons given the increasing age and preexisting disease burden of today’s surgical patients. Managing these patients and their complications imposes substantial demands on care teams and the financiers of their care,” authors say.
The intensity of medical care varies around the country. Intensity is synonymous with an aggressive treatment style and it has been implicated in rising health care costs, especially during the end-of-life period.
Inpatient surgery also is a cost burden. The authors analyzed national Medicare data to examine increased HCI and outcomes after major surgery.
The data identified 706,520 patients at 2,544 hospitals who underwent 1 of 7 major cardiovascular, orthopedic or general surgical operations. The Dartmouth Atlas provides metrics of health care intensity for Medicare beneficiaries in their last two years of life.
This article was originally published by the University of Michigan Health System on Oct. 1, 2014.