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Invited Commentary
August 14, 2019

Surgical Hot Spotting: Who Becomes a Super-Utilizer After Surgery?

Author Affiliations
  • 1Institute for Healthcare Policy and Innovation, National Clinician Scholars Program, University of Michigan, Ann Arbor
  • 2Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 3Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. Published online August 14, 2019. doi:10.1001/jamasurg.2019.2999

Surgeons have long known that there is a subset of patients with much more complicated—and expensive—postoperative courses than the rest. In this issue of JAMA Surgery, Hyer et al1 add to our knowledge of these “super-utilizers” by studying Medicare patients’ total health care spending across the entire 12 months following surgery. Using machine learning methods, their study identified a group of super-utilizers who made up 4.8% of the total cohort but incurred 31.7% of its total spending. Compared with propensity-matched low users, these super-utilizer patients had vastly higher spending in the year following surgery ($79 698 vs $2977), showing that the consequences of surgery go well beyond the traditional 30- or 90-day period examined in most research.

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