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Women suffer fewer postoperative problems after vascular surgery at Veterans Administration than at private hospitals

Women's mortality rates one month after vascular surgery at Veterans Administration (VA) and private sector hospitals are similar, after adjusting for differences in severity of illness. However, postoperative problems are 40 percent fewer at VA than they are at private hospitals, even after adjusting for these differences, according to a new study.

A research team used data from the Patient Safety in Surgery Study to compare postoperative mortality and morbidity between 458 women who underwent vascular surgery at 128 VA hospitals and 3,535 women who underwent surgery at 14 private sector medical centers between 2001 and 2004. Operations included surgery on the carotid artery and below- or above-the-knee amputations.

The private hospital group had more preoperative health problems than the VA group, which ranged from renal failure and heart failure to wound infection and bleeding disorders. Without adjusting for these differences, the 30-day mortality rate was higher in the private group than it was in the VA group (5.2 vs. 2.4 percent), as was the morbidity rate (23.4 vs. 13.3 percent).

After adjusting for differences in preoperative severity of illness, mortality rates were similar between the two groups. However, the difference in postoperative problems remained pronounced, with the VA group suffering from 40 percent fewer postoperative problems than the private group. Postoperative complications that were more frequent among the private sector patients were deep wound infection, respiratory failure, urinary tract infections, cardiac arrest, and graft failure.

These differences in postoperative complications suggest unidentified differences in the hospital populations, their processes of care, or both. For example, a greater percentage of the VA patients were operated on with epidural and monitored techniques. Also, the technical complexity of the surgeries was substantially higher in the private group, and these surgeries were more likely to be emergencies. The study was supported by the Agency for Healthcare Research and Quality (HS11913).

See "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 women," by Robert G. Johnson, M.D., F.A.C.S., Catherine M. Wittgen, M.D., F.A.C.S., Matthew M. Hutter, M.D., M.P.H., F.A.C.S., and others, in the June 2007 Journal of the American College of Surgeons 204(6), pp. 1137-1146.

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