Surgeons at Hospital A report that the mortality rate at the end of a one-year follow-up after a new coronary bypass procedure is 15%. At Hospital B, the surgeons report a one-year mortality rate of 8% for the same procedure. Before concluding that the surgeons at Hospital B have vastly superior skill, which of the following possible confounders would you examine? a. the severity (stage) of disease of the patients at the two hospitals at baseline
b. the start of the one-year follow-up at both hospitals (after operation versus after discharge)
c. differences in postoperative care at the two hospitals
d. equality of follow-up for mortality
e. all of the above

All of the above.

Explanation:

To answer this, one must first take into account the severity of the disease with which the patient came to the hospital. Because it is not appropriate to only compare the treatment of a hospital that received a patient with something mild, with the treatment of another hospital that received another patient but with a serious illness or damage. Clearly, this second hospital is going to face a greater challenge in trying to save the life of the person who has come in. It is not the same to operate on a serious patient on the verge of death, as it is to operate on a healthy one for something minor that just because of that alone has a higher chance of survival. If something goes wrong, it is not necessarily or not entirely the hospital's responsibility. Someone who is more compromised in terms of their health will be more vulnerable and require greater care. While the hospital must be able to do this (and there may be some that are better than others) it must be kept in mind that the patient's previous health.

The onset of one-year follow-up at both hospitals (post-operative versus discharge) will differ significantly between the two hospitals. Each hospital will have have different staff, different doctors and nurses, different equipment and ways of handling. All this makes the treatments vary a lot from one hospital to another.

Something similar occurs with tje differences in postoperative care, that may vary from place to place. However it also depend on the underlying condition with which the patient has come, postoperative care also varies according to how the staff is managed, the hygiene of the site, the resources available, and others. The same applies to equal follow-up for mortality.

In summary, for all options it is necessary to keep in mind that while hospital care and staff training are very important, there is one variable that is beyond the scope of what doctors and nurses can do, and that is the severity with which the patient has come for care. The more serious the patient is, the more difficult it is going to be to treat him/her. However, the more modern the hospital and the better trained its staff, the more likely it is to cure more people.

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