COMPARISON OF POSTOPERATIVE MORTALITY AND MORBIDITY IN VA AND NONFEDERAL HOSPITALS

We compared postoperative mortality and morbidity fates in the Veteran s Health Administration (VA) to those in nonfederal hospitals, using m ultivariate analysis to adjust for the patient characteristics of age, diagnosis, comorbidity, and severity of illness. We used a total of 5 44,000 patient discharge records (330,000 nonfederal and 214,000 VA) f rom 1987 through 1988 and compared 118 surgical procedures or procedur e groups composed of 314 individual surgical procedures. We found no s ignificant differences in postoperative mortality rates between the VA and nonfederal hospital systems for 110 of 118 surgical procedures or procedure groups. Endarterectomy, cervical esophagostomy, and esophag eal anastomosis or esophagocolostomy showed significantly lower postop erative mortality in the VA hospitals compared to nonfederal hospitals (P = 0.05). VA postoperative mortality rates that were higher than th ose in nonfederal hospitals and could not be entirely explained by adj usting for patient characteristics were found for suture of ulcer, cho lecystostomy, colon surgery, small intestine surgery, and reopening of recent thoracotomy site (P = 0.05). Respiratory, gastrointestinal, an d urinary postoperative morbidity were generally lower in the VA hospi tals than in nonfederal hospitals (P = 0.05). Infections were generall y higher in the VA hospitals than in nonfederal hospitals. Pulmonary e mbolism, deep venous thrombosis, shock due to surgery or anesthesia, m ediastinitis, hemorrhage, cardiac, and central nervous system morbidit y showed no significant differences. These data demonstrate that VA po stoperative mortality and morbidity in 118 surgical procedures or proc edure groups is comparable to those in nonfederal hospitals. (C) 1994 Academic Press, Inc.