Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: vascular surgical operations in men.
BACKGROUND
In response to a Congressional mandate to compare risk-adjusted surgical outcomes from Department of Veterans Affairs (VA) hospitals with those from private-sector hospitals, the National Surgical Quality Improvement Program was initiated in the VA system and then was developed in a select group of university medical centers in the private sector. This article analyzes risk-adjusted outcomes after vascular surgical operations in men performed at VA hospitals as compared with private-sector hospitals.


METHODS
This is a prospective cohort study of a sample of vascular surgical operations in men performed at 128 VA medical centers as compared with 14 university medical centers from October 1, 2001 to September 30, 2004. Patient and operative characteristics, and both unadjusted and risk-adjusted 30-day postoperative morbidity and mortality outcomes were compared.


RESULTS
Data from 30,058 vascular operations in men at VA hospitals were compared with 5,174 cases performed at private-sector hospitals. The unadjusted 30-day mortality rate was notably lower in the VA system as compared with the private-sector group (3.4% versus 4.2%, p = 0.004). After risk-adjustment, there was no marked difference in mortality between the two hospital types. The unadjusted 30-day morbidity rate was also considerably lower in the VA hospitals as compared with the private sector (17.3% versus 22.3%, p < 0.0001). After risk-adjustment, morbidity in the VA system remained considerably lower than in the private sector, with an odds ratio of 0.84 (95% CI, 0.78 to 0.92).


CONCLUSIONS
In vascular surgical operations in men, the VA hospitals demonstrated a lower risk-adjusted 30-day morbidity rate than the private-sector group. There is no marked difference in adjusted mortality rates between the two types of institutions.
Hutter
Matthew M
MM
Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. mhutter@partners.org
Lancaster
Robert T
RT
Henderson
William G
WG
Khuri
Shukri F
SF
Mosca
Cecilia
C
Johnson
Robert G
RG
Abbott
William M
WM
Cambria
Richard P
RP
D000046:Academic Medical Centers / Q000592:standards; D000368:Aged; D015331:Cohort Studies; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D017149:Private Sector; D011446:Prospective Studies; D012449:Safety; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000401:mortality*