• Posted May 11, 2023

VA Hospitals Offer Quality Surgical Care: Review

While the U.S. Veterans Affairs health system has been criticized for long appointment wait times and limited access to specialists, the quality of care and access to a range of surgical services is as good as or better than at non-VA health centers on several measures, new research reveals.

"Surgery involves many steps of care,"said lead study author Dr. Mariah Blegen, a fellow in the department of surgery at the University of California, Los Angeles David Geffen School of Medicine.

"This updated review is important because it tells us that the veterans at the VA are getting good care. Quality improvement, through the VA National Surgical Quality Improvement Program (VA NSQIP), has been the focus of the VA for several decades and I think this effort is paying off,"Blegen said in a news release from the American College of Surgeons. The findings were published online May 8 in the Journal of the American College of Surgeons.

VA NSQIP has helped track millions of surgical cases and improve outcomes, including improved rates of postoperative death and infection, according to the researchers.

"The database continues to drive statistically reliable research that can help VA hospitals better assess its surgical outcomes and develop quality improvement programs,"said Dr. Clifford Ko, director of the ACS Division of Research and Optimal Patient Care.

After the success of VA NSQIP in improving outcomes in VA hospitals, the American College of Surgeons National Surgical Quality Improvement Program was launched in 2001 for private sector hospitals.

Collecting this clinical data makes it possible to compare surgical outcomes among all participating hospitals.

The researchers behind the new paper reviewed all available studies conducted between 2015 and 2021.

They found 18 nationally representative studies that evaluated the same four quality measures: quality of care, access to care, cost and efficiency, and patient satisfaction across a range of surgical specialties.

The studies included orthopedic surgery, cataract surgery, lung resections, kidney transplants and coronary artery bypass grafting.

Among the findings:

• Eleven of the 13 studies focused on quality and safety outcomes showed that the quality and safety of surgical care provided in VA health centers was the same as, if not better than, care received in non-VA health centers.
• In a study focused on elective joint replacement, VA patients were less likely to develop complications after surgery compared to veterans in a non-VA site. Veterans undergoing joint replacement at VA hospitals also had lower readmission numbers compared to veterans having the procedure done in a non-VA setting.
• Veterans in VA health care settings had a lower 30-day death rate than the general population in non-VA settings.
• A study on kidney transplants showed no difference in the death rates between VA sites and other medical centers.

"Among the studies included in the review that had the most robust comparison of veterans in the VA and non-VA sites, all of these outcomes were at least equal or showed better outcomes for veterans, apart from cost or length of stay,"Blegen said. "Overall, this is good news for how veterans are doing in terms of quality and safety."

Among the studies focusing on access to health care, about two-thirds found no consistent advantage to receiving care in a VA setting over care outside the VA system. The studies covered time to care and geographic access.

Geographic access to care in the VA system was mixed.

In terms of cost, one study showed that the average cost for total knee replacement was almost twice as high for VA care compared to non-VA care.

Cataract surgery and elective coronary artery bypass surgery cost substantially more at a VA medical center. Two studies showed that veterans at VA hospitals had longer lengths of stays, compared to the general population at non-VA hospitals.

The study had limitations: It aggregated national data, so may not apply to individual health care systems. Also, findings from some surgical procedures may not be generalized to all procedures, the authors noted.

More information

The RAND Corporation has more on veterans' health care.

SOURCE: American College of Surgeons, news release, May 9, 2023