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Hospital Outcomes Research Named "Article of the Year"
Date:6/13/2011

such a belief may be incorrect, and that cutting spending through reductions in aggressiveness may lead to worse outcomes. We should not kid ourselves that the process of reducing Medicare expenditure will be a painless one."

Much of the high cost associated with surgery is the result of complications. "We studied whether more aggressive measures lead to more complications, and found there was no difference in complication rates between aggressive and less-aggressive hospitals," said Silber, adding, "However, when complications arise, patients are more likely to survive those complications if they receive aggressive treatment."

The survival rates after 30 days were important, said Silber. After that period, patients at both aggressive and less aggressive hospitals had equal survival rates one year after admission; there was just a greater initial chance of surviving at the more aggressive hospitals. "It appears," said Silber, "that the survival benefits gained at aggressive hospitals are as stable as in patients who survive at less aggressive ones, suggesting that the life saved at more aggressive hospitals is not more fragile or fleeting than a survivor in the less aggressive hospital."

The journal articles attracted some press attention earlier this year when they were described in February online articles in the New York Times. At the time, Silber said, "Most people have been saying that the health care system is too aggressive, implying that aggressiveness is bad because people are being operated on unnecessarily…But we have to do detailed research that compares the effectiveness of different treatment approaches, because aggressiveness is not necessarily bad and may in fact be sometimes associated with better outcomes."

Ultimately, concluded Silber, his research shows that cost-cutting in health care must be done carefully and based on evidence: "It matters how we cut expenditures, because although some spending may be i
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SOURCE The Children's Hospital of Philadelphia
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