Community-Based Surgery and Postoperative Survival Among Veterans Affairs Enrollees

Area of Science:

• Health Services Research
• Surgical Outcomes
• Veterans Health Administration

Background:

• The VA MISSION Act of 2018 expanded access to community care for Veterans.
• Utilization of community-based services has increased significantly.
• Comparative quality of noncardiac surgical procedures between VA and community care is not well-established.

Purpose of the Study:

• To compare surgical outcomes and survival rates among Veterans receiving care in VA versus community care facilities.
• To analyze differences in post-operative survival following specific noncardiac surgical procedures.

Main Methods:

• Retrospective cohort study analyzing data from October 1, 2019, to July 31, 2024.
• Compared survival at 30, 90, and 365 days using adjusted restricted mean survival time (RMST).
• Included carotid endarterectomy (CEA), cholecystectomy (CCY), total hip arthroplasty (THA), and total knee arthroplasty (TKA).

Main Results:

• Over 215,000 procedures were analyzed; 87,653 in VA and 127,889 in community care.
• Higher mortality rates observed for community-based CEA and CCY compared to VA settings.
• Survival times at 30, 90, and 365 days were significantly longer in VA settings for CEA and CCY; survival was similar for THA and TKA.

Conclusions:

• Veterans undergoing CEA and CCY experienced decreased survival times in community care facilities compared to VA facilities.
• Survival outcomes for THA and TKA were comparable between VA and community care settings.
• The reasons behind observed survival disparities warrant further investigation.