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Invited Commentary
July 2013

Cost of and Access to Surgical CareHow Much, and How Far?

Author Affiliations
  • 1Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
JAMA Surg. 2013;148(7):596. doi:10.1001/jamasurg.2013.1242

Gadzinski et al1 found that that while mortality rates are similar between CAHs and non-CAHs, costs are higher in critical access settings, even when patients leave the hospital sooner.

Several aspects of this study deserve comment. First, this study found no differences in perioperative mortality between CAHs and non-CAHs. While perioperative mortality is a convenient end point, many have suggested that it is of limited use in detecting quality differences, especially at the sample sizes that occur in most CAHs.2,3 While this study represents a good starting point, future work will certainly use more granular markers of surgical quality.

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