, PA — A Department of Veterans Affairs study found that veterans who undergo non-cardiac surgery at VA hospitals have a 40% lower adjusted risk of 30-day mortality than in the private sector.
Published in JAMA Surgery, the study compared the 30-day postoperative mortality/complications data of more than 4.6 million operations — controlling for patient- and procedure-level variation, including patient frailty and operative stress — from Jan. 1, 2015, to Dec. 31, 2018.
The results “challenge the assumption that shifting care to the private sector can improve timeliness of surgical care without diminishing its quality,” according to the study. These untested assumptions may have contributed to increasing veteran access to private sector physicians and services through the Choice and MISSION acts, which give veterans access to subsidized health care in the private sector.
“If the private sector can provide equally high-quality care in a more timely fashion, that’s great,” said Dr. Paula K. Shireman, a study co-author from South Texas Veterans Health Care System. “But timeliness is only one aspect of high-value care — the outcomes need to be good as well, and these data put the burden of proof on those who assert that the private sector is as good or better than the VA for providing surgical services and ensuring optimal surgical outcomes for veterans.”
For frail and very frail patients, the risk of death within 30 days of surgery was even lower, “suggesting that the VA might be particularly adept at caring for such higher risk patients who represent a larger proportion of the patients treated by the VA,” said another study co-author, Dr. Shipra Arya, from VA Palo Alto Health Care System.
VA is also uniquely positioned to care for veterans’ additional needs, taking mental health, addiction treatment, transportation and housing into consideration when providing surgical care.
“The VA’s wraparound services and integrated care networks provide significant value to my patients,” said senior author Dr. Daniel E. Hall, VA Pittsburgh Healthcare System surgeon and core investigator with VA’s Center for Health Equity Research and Promotion. “That might go a long way to explaining these findings.”
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VA Pittsburgh Healthcare System (VAPHS) is one of the largest and most progressive VA health care systems in the nation. More than 4,000 employees serve nearly 80,000 veterans every year, providing a range of services from complex transplant medicine to routine primary care. VAPHS is a leader in virtual care delivery through telehealth technology; a center of research and learning with 130 research investigators and $14.8 million in funding; and a provider of state-of-the-art health care training to some 1,500 student trainees annually. VAPHS provides care at medical centers in Oakland and O’Hara Township in Pennsylvania and five outpatient clinics in Belmont County, Ohio, and Beaver, Fayette, Washington and Westmoreland counties in Pennsylvania. Veterans can call 412-360-6162 to check eligibility or enrollment. Stay up to date at pittsburgh.va.gov, Facebook and Twitter.