‘High-Intensity’ Hospitals Save More Elderly After Surgery: Study

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Hospitals that pull out all the stops to rescue surgical patients in crisis are slightly better at saving lives, but the cost of such heroism is questionable, a new study suggests.

Highly aggressive hospitals are about 5 percent better at saving elderly patients with life-threatening complications after major surgery, compared with hospitals that operate with less intensity, said senior author Dr. Amir Ghaferi. He is assistant professor of surgery and chief of the Division of Veterans Administration at the University of Michigan Health Systems.

“There was some benefit to being treated at a high-intensity hospital, where patients had a slight improvement in their rescue rates, but it wasn’t a huge effect,” Ghaferi said.

But these aggressive hospitals have slightly higher rates of major complications and more inpatient deaths, Ghaferi and his colleagues found. Patients tend to remain hospitalized longer in these facilities, and are less likely to turn to hospice during their final years of life.

Hospitals might do better by patients if, instead of throwing resources toward saving those in crisis, they instead focus on detecting and preventing potentially life-threatening complications, Ghaferi said.

“An ounce of prevention is worth a pound of cure. That’s exactly the right idea,” he said. “You want to catch the problem before that first domino falls, because once that domino falls, it’s hard to stop it from progressing from one complication to another and, ultimately, to death.”

In this study, published online Oct. 1 in the journal JAMA Surgery, researchers used national Medicare data to identify more than 706,000 patients aged 65 and older who underwent major surgery at over 2,500 hospitals. The investigators noted their outcomes and any major complications.

The researchers then judged each hospital’s aggressiveness using measures taken from the Dartmouth Atlas of Healthcare, in particular the Hospital Care Intensity Index. This index evaluates a hospital’s willingness to aggressively treat Medicare patients during their last two years of life.

The intensity of care provided by hospitals varied dramatically across the country, with the most aggressive hospitals displaying 10 times the intensity of the most passive hospitals, the researchers found.

Overall, patients who had surgery at an aggressive hospital were 5 percent less likely to die of a major complication.

But the highly aggressive hospitals also:

• Ran up higher Medicare costs, charging more than $47,000 per inpatient compared with about $29,500 per inpatient for the least intense hospitals.
• Kept patients longer, with an average hospital stay of 25 days compared with 16 days for low-intensity hospitals.
• Had more inpatient deaths — about 31 percent of all deaths compared with 26 percent in low-intensity hospitals.
• Were less likely to refer patients to hospice. Patients at low-intensity hospitals spent an average of 19 days in hospice, compared with 17 days for aggressive hospitals.

“This means they are spending their final days and dying in the hospital, rather than being discharged someplace where they can die more peacefully, with their family,” Ghaferi said.

Ghaferi hopes the study will promote discussion of how best to use a hospital’s resources when caring for people who have undergone major surgery.

Utilization of resources by itself doesn’t lead to safer outcomes when it comes to major surgery, he said. “Hospitals need to pay attention not necessarily to how much they’re doing as to how they are coordinating that care,” he added. “How can we develop a system based on teamwork and cooperation, where we do pick up problems sooner?”

More information

For more information on surgery, visit the U.S. National Institutes of Health.

Source: HealthDay

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