Quality of bariatric surgery at Veterans Affairs versus community care hospitals

Under the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, Veterans can obtain Veterans Health Administration (VHA)-funded care in the community; however, there are limited studies on Veteran outcomes following bariatric surgery.

We performed a national retrospective study of Veterans undergoing bariatric surgery between fiscal years 2022-2023. Data were collected through VHA administrative databases. Differences in baseline characteristics and length of stay were assessed with two-sided t-tests or Wilcoxon Sign Rank tests for continuous variables and Pearson's Chi-square or Fisher's Exact tests for categorical outcomes. Differences in 30-day emergency room visit, 30-day readmissions and both 30-day and 1-year mortality were estimated with log binomial models adjusted for baseline characteristics and expressed as relative risk (RR).

Three thousand three hundred ninety Veterans met inclusion criteria, and 1730 (51%) underwent bariatric surgery within the VHA and 1660 (49%) within the community. VHA Veterans were younger (p = .035), comprised of fewer white (p < .001), more Hispanic (p < .001), more urban-residing individuals (p < .001), had less comorbidities (p = .026), lower BMI (p < .001), and shorter length of stay (p < .001) compared to community care Veterans. Compared to VHA, Veterans in the community were more likely to undergo Roux-en-Y (VHA: 46% vs. Community: 33%, p < .001) and less likely to undergo gastroplasty (VHA: 67% vs. Community: 54%, p < .001). Community care Veterans were less likely to have an emergency department visit within 30 days (Adjusted RR = 0.78, 95% Confidence Interval, 0.63-0.97, p < .001) but did not have statistically significant differences in 30-day readmissions and neither 30-day nor 1-year mortality.

Despite the increased risk in 30-day emergency department visits among VHA Veterans following bariatric surgery, morbidity and mortality are comparable between VHA and community care Veterans. Further investigation accounting for consult timeliness and cost should be conducted to fully evaluate differences in quality and access to care.