Housing Status and Receipt of Unplanned Operation in US Veterans

People experiencing homelessness experience a disproportionately high rate of unplanned operations, suggesting barriers to timely elective surgical care. Whether these disparities persist within the Veterans Health Administration, which prioritizes supportive services for Veterans experiencing homelessness, remains unclear.

We conducted a retrospective cohort study of Veterans undergoing abdominal aortic aneurysm repair, incisional hernia repair, or colectomy for access-sensitive surgical conditions between 2012 and 2019. Housing status was determined using multiple measures, and operations performed both within and outside the VA were identified. The primary outcome was unplanned operation.

Among 78,483 operations (29,034 abdominal aortic aneurysm repairs, 34,327 incisional hernia repairs, and 15,122 colectomies), 19% (15,195) were unplanned. The proportion of unplanned operations varied by procedure (abdominal aortic aneurysm repair 24%, incisional hernia repair 18%, colectomy 13%). Veterans experiencing homelessness comprised 4% of the cohort (2,903). After adjustment for confounding covariates, homelessness was associated with a 14% higher likelihood of unplanned abdominal aortic aneurysm repair (95% CI 1.01-1.29; p=0.04), whereas no significant association was observed for incisional hernia repair or colectomy.

Nearly one in five Veterans underwent an unplanned operation for access-sensitive surgical conditions, a lower proportion than previously reported outside the VA. Minimal disparities in access to scheduled operation by housing status suggest that features of the VA care model may help reduce inequities in surgical access among people experiencing homelessness.