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Comment & Response
July 2017

Inaccurate Claims About VA Surgical Quality Might Mislead Veterans—Reply

Author Affiliations
  • 1Department of Surgery, Nebraska Western Iowa VA Medical Center, Omaha
  • 2Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, Georgia
JAMA Surg. 2017;152(7):708. doi:10.1001/jamasurg.2017.0509

In Reply We thank Weeks for his comments. Based on his letter, we infer that he is focusing on selected studies to support his point of view. However, as noted in the systematic review he references, “The VA [Veterans Affairs] often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care. Additional studies of quality of care in the VA are needed on all aspects of quality, but particularly with regard to timeliness, equity, efficiency, and patient-centeredness.”1 Specifically, for surgery, the RAND Corporation study concludes, “Mortality rates associated with specific conditions or following surgery were often similar for VA patients compared with non-veterans, and occasionally lower. However, some studies found higher surgical mortality among VA patients compared with non-veterans.”1 The study also concludes, “Postoperative morbidity was lower for VA patients compared with non-veterans in some surgeries while for other surgeries it was similar.”1 These findings are also consistent with a separate evidence-based systematic review2 that concluded, “Studies looking at risk-adjusted outcomes generally have found no differences between VA and non-VA care, with some reports of better outcomes in VA and a few reports of worse outcomes in VA, compared to non-VA care.” Based on the above systematic reviews, we stand by our statements regarding surgical care of VA patients.

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