ImportanceThere are 2 degree programs for licensed physicians in the US: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons.ObjectiveTo evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO).Design, Setting, and ParticipantsThis retrospective cohort study used 100% Medicare claims data from inpatient hospitals providing surgical services from January 1, 2016, to December 31, 2019 among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of the 14 most common surgical procedures. Data analysis was performed from January 17, 2023, to August 13, 2024.ExposureMedical school degree (MD vs DO).Main Outcomes and MeasuresThe primary outcome was 30-day mortality, and the secondary outcomes were readmissions and length of stay. To assess differences between surgeons by medical school training, a multivariable linear probability model was used, which was adjusted for hospital fixed effects and patient, procedure, and surgeon characteristics.ResultsOf the 2 360 108 total surgical procedures analyzed, 2 154 562 (91.3%) were performed by MD surgeons, and 205 546 (8.7%) were performed by DO surgeons. Of 43 651 total surgeons, most surgeons were MDs (39 339 [90.1%]), the median (SD) age was 49.0 (9.8) years, and 6649 surgeons (15.2%) were female. The mean (SD) age of patients undergoing surgical procedures was 74.9 (6.7) years, 1 353 818 of 2 360 108 patients (57.4%) were female, and 2 110 611 patients (89.4%) self-reported as White. DO surgeons were significantly more likely to operate on older patients (DO patient mean [SD] age: 75.3 [7.1] years; MD patient mean [SD] age: 74.8 [6.6]), female patients (DO: 60.2% of patients; MD: 57.1% of patients), and Medicaid dual-eligible patients (DO: 10.3% of patients; MD: 8.6% of patients). DOs performed a lower proportion of elective operations (DO: 74.2% vs MD: 80.2%) and were more likely to work in public hospitals (DO: 10.3%; MD: 9.5%) and nonteaching hospitals (DO: 57.9%; MD: 68.1%). There was no evidence that 30-day mortality differed between MD and DO surgeons (adjusted mortality rate, DO: 1.61%; MD: 1.58%; absolute risk difference [aRD], −0.04 percentage points; 95% CI, −0.11 to 0.04; P = .37). On secondary analyses, no difference was found in 30-day readmissions or length of stay between MD and DO surgeons.Conclusions and RelevanceIn this retrospective cohort study using Medicare data, there was no evidence that patient outcomes differed between MD and DO surgeons for common operations after adjusting for patient factors and practice settings.

中文翻译：

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对抗疗法与整骨疗法外科医生治疗的患者的结果比较


重要性美国有 2 个针对执业医师的学位课程：对抗疗法医学博士学位 （MD） 和整骨疗法博士学位 （DO）。然而，关于 MD 与 DO 外科医生治疗的患者之间的结局是否不同，证据有限。目的评估外科医生医学院培训 （MD vs DO） 手术结局和实践模式的差异。设计、设置和参与者这项回顾性队列研究使用了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间提供外科服务的住院医院的 100% 医疗保险索赔数据，这些受益人年龄在 65 至 99 岁之间，他们接受了 14 种最常见的外科手术中的 1 种。数据分析于 2023 年 1 月 17 日至 2024 年 8 月 13 日进行。主要结局和测量主要结局是 30 天死亡率，次要结局是再入院和住院时间。为了通过医学院培训评估外科医生之间的差异，使用了多变量线性概率模型，该模型根据医院固定效应和患者、手术和外科医生特征进行了调整。结果在分析的 2 360 108 例外科手术中，MD 外科医生实施了 2 154 562 例 （91.3%），DO 外科医生实施了 205 546 例 （8.7%）。在总共 43 651 名外科医生中，大多数外科医生是 MD （39 339 [90.1%]），中位 （SD） 年龄为 49.0 （9.8） 岁，6649 名外科医生 （15.2%） 为女性。接受外科手术的患者的平均 （SD） 年龄为 74.9 （6.7） 岁，2 360 108 例患者中有 1 353 818 例 （57.4%） 为女性，2 110 611 例患者 （89.4%） 自我报告为白人。DO 外科医生明显更有可能对老年患者进行手术 （DO 患者平均 [SD] 年龄：75.3 [7.1] 岁;MD 患者平均 [SD] 年龄：74.8 [6.6]）、女性患者 （DO： 60.2% 的患者;MD：57.1% 的患者）和 Medicaid 双重资格患者（DO：10.3% 的患者;MD：8.6% 的患者）。DO 执行的择期手术比例较低 （DO： 74.2% vs MD： 80.2%） 并且更有可能在公立医院工作 （DO： 10.3%;MD：9.5%）和非教学医院（DO：57.9%;MD：68.1%）。没有证据表明 MD 和 DO 外科医生之间的 30 天死亡率存在差异（调整后的死亡率，DO：1.61%;MD： 1.58%;绝对风险差 [aRD]，-0.04 个百分点;95% CI，-0.11 至 0.04;P = .37）。在二次分析中，未发现 MD 和 DO 外科医生之间的 30 天再入院率或住院时间存在差异。结论和相关性在这项使用 Medicare 数据的回顾性队列研究中，没有证据表明在调整患者因素和实践环境后，MD 和 DO 外科医生在常见手术中的患者结局存在差异。