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Postsurgical Mortality in Manitoba and New England
Leslie L. Roos, PhD;
Elliott S. Fisher, MD, MPH;
Sandra M. Sharp, MSc;
Joseph P. Newhouse, PhD;
Geoffrey Anderson, MD, PhD;
Thomas A. Bubolz, PhD
JAMA. 1990;263(18):2453-2458.
Abstract
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Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.
(JAMA. 1990;263:2453-2458)
Author Affiliations
From the Departments of Community Health Sciences and Business Administration, The University of Manitoba, Winnipeg, Canada (Dr Roos); the Departments of Medicine (Dr Fisher) and Community and Family Medicine (Drs Fisher and Bubolz and Ms Sharp), Dartmouth Medical School, Hanover, NH; the Department of Veterans Affairs Medical Center, White River Junction, Vt (Dr Fisher); the Schools of Government, Medicine, and Public Health, Harvard University, Cambridge, Mass (Dr Newhouse); and the Division of Health Services Research and Development, University of British Columbia, Vancouver, Canada (Dr Anderson).
Footnotes
Reprint requests to 468 Drake Centre, University of Manitoba, Winnipeg, Manitoba, Canada R3T 2N2 (Dr Roos).
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