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Invited Critique
Aug 2011

Searching for True Costs and Outcomes in Surgical Care: Comment on “High-Quality, Low-Cost Gastrectomy Care at High-Volume Hospitals”

Author Affiliations

Author Affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, and Michael Pine and Associates, Chicago, Illinois and School of Medicine, University of New Mexico, Albuquerque.

Arch Surg. 2011;146(8):936-937. doi:10.1001/archsurg.2011.89

Lee and associates observe that high-volume hospitals have lower costs and shorter LOS than low-volume hospitals for partial gastric resections in patients with gastric cancer. By using ratios of observed to expected death rates, they conclude that outcomes are equal across hospital size but lower costs justify gastrectomy being performed only at high-volume hospitals.

But do the metrics used in the study truly measure cost and quality of a surgical episode when only in-hospital expenditures and inpatient death rates are examined? Although the authors have used standard methods for predicting inpatient costs and deaths, their research, like my own, suffers from not having postdischarge events that may reveal the true cost-effectiveness of the care provided.