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In This Issue of JAMA Surgery | Association of VA Surgeons

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JAMA Surg. 2014;149(11):1097. doi:10.1001/jamasurg.2013.3509.
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Patients who experience postoperative complications and die (failure to rescue) can be used as a quality metric that discriminates surgical programs. An observational study of nearly 2 million patients entered into the American College of Surgeons National Surgical Quality Improvement Program database found that 20% of high-risk patients account for 90% of failure to rescue (Pareto principle). A risk-scoring system for failure to rescue predicted patients in the highest-risk quintile with good predictive accuracy.

Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines, revised in 2007, recommend delaying elective noncardiac surgery by 365 days for patients with a drug-eluting stent to reduce the risk of major adverse cardiac events (MACEs). Graham and colleagues retrospectively identified patients undergoing noncardiac surgery and queried administrative databases to determine whether the revised guidelines were effective. The guidelines increased the time between stenting and surgery and resulted in a slight reduction in MACEs.

The effect of implementing a multidisciplinary hepatopancreaticobiliary surgical program (HPB-SP) on regionalization of care, the quality of cancer care, and surgical outcomes within an integrated health care system is unknown. Lau et al performed a retrospective cohort study of patients with HPB tumors, evaluated at a tertiary referral Veterans Affairs medical center, to determine the effect of an HPB-SP on access to care regionally and on quality and outcomes of the cancer care process. Establishment of the HBP-SP resulted in regionalization of care and improved the cancer care process and surgical-related outcomes.

Readmission following inpatient surgery is costly for patients and health care systems. Han and coauthors evaluated trends of 30-day readmission rates, diagnoses, and postoperative hospital length of stay (POHLOS) using 894 943 records representing the 9 surgical specialties of the Veterans Affairs Surgical Quality Improvement Program. Readmission rates and average POHLOS declined from October 1, 2000, through September 30, 2010. Readmission diagnoses varied within specialties, but postoperative infections, urinary tract infections, and pneumonia were observed across specialties.

Evidence suggests that surgical patients were significantly less likely than medical patients to receive either hospice or palliative care. Olmsted et al used Veterans Health Administration (VHA) data to examine the use of palliative care for 191 280 VHA patients who died between October 1, 2008, and September 30, 2012. It was found that surgical patients were less likely than medical patients to receive palliative care.





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