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Special Communication
January 20, 2021

Sentinel Contributions of US Department of Veterans Affairs Surgeons in Shaping the Face of Health Care

Author Affiliations
  • 1Department of Surgery, W. G. (Bill) Hefner Veterans Affairs (VA) Health Care System, Salisbury, North Carolina
  • 2Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
  • 3Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
  • 4Department of Surgery, VA Boston Health Care System, Boston, Massachusetts
  • 5Department of Surgery, Boston University, Boston, Massachusetts
  • 6Department of Surgery, Harvard Medical School, Boston, Massachusetts
  • 7Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 8Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 9Department of Surgery, Kansas Veterans Affairs Medical Center (VAMC), Kansas City, Missouri
  • 10Department of Surgery, University of Missouri, Kansas City
  • 11Department of Surgery, Miami VAMC, Miami, Florida
  • 12Department of Surgery, University of Miami School of Medicine, Miami, Florida
  • 13Department of Surgery, University of Rochester School of Medicine, Rochester, New York
  • 14Department of Surgery, West Haven VAMC, West Haven, Connecticut
  • 15Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
  • 16Department of Surgery, Brooklyn VAMC, Brooklyn, New York
  • 17VA Maryland Health Care System, Baltimore
  • 18Department of Surgery, University of Maryland School of Medicine, Baltimore
  • 19Department of Surgery, Cleveland VAMC, Cleveland, Ohio
  • 20Department of Surgery, Madison VAMC, Madison, Wisconsin
  • 21Department of Surgery, University of Wisconsin, Madison
  • 22JFK Medical Center, West Palm Beach, Florida
  • 23Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
JAMA Surg. 2021;156(4):380-386. doi:10.1001/jamasurg.2020.6372
Abstract

The vast accomplishments of the US Department of Veterans Affairs (VA) during the past century have contributed to the advancement of medicine and benefited patients worldwide. This article highlights some of those accomplishments and the advantages in the VA system that promulgated those successes. Through its affiliation with medical schools, its formation of a structured research and development program, its Cooperative Studies Program, and its National Surgical Quality Improvement Program, the VA has led the world in the progress of health care. The exigencies of war led not only to the organization of VA health care but also to groundbreaking, landmark developments in colon surgery; surgical treatments for vascular disease, including vascular grafts, carotid surgery, and arteriovenous dialysis fistulas; cardiac surgery, including implantable cardiac pacemaker and coronary artery bypass surgery; and the surgical management of many conditions, such as hernias. The birth of successful liver transplantation was also seen within the VA, and countless other achievements have benefited patients around the globe. These successes have created an environment where residents and medical students are able to obtain superb education and postgraduate training and where faculty are able to develop their clinical and academic careers.

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    1 Comment for this article
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    building success in research
    Toby Richards, MD FRCS FRACS | University of Western Australia
    Dear Dr Lipshy

    I always encourage medical students to write to the author of an article they like or question. So, I would like to congratulate you on your article in JAMA Surgery. There is a key component of the VA database that I would like to highlight. That is ability to have a large volume of data that can be rigorously interrogated. This teaches future academics how to undertake the first principles of research and the use of statistics. These data suggest association and are hypothesis generating for larger clinical trials.

    My career in research
    has been based on collaboration and development of clinical trials in Surgery. We were fortunate to form a link between UCL, Zurich and Lebanon to work with the VA and assess the impact of preoperative anemia on outcomes in non-cardiac surgery. Published a decade ago in the LANCET this caused a pivotal change to recognise that anaemia in surgery was associated with adverse patient outcomes. Now recognised by the WHO. https://www.sciencedirect.com/science/article/abs/pii/S0140673611613810

    On the back of this we gained a UK NIHR HTA grant to run a large multicentre RCT that was recently published. Despite a great question and plausible management plan preoperative intravenous iron was not the magic bullet in this setting. Demonstrating the need for well conducted research to any great idea.
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31539-7/fulltext

    I have now supervised over 50 postgraduate research students, run a few trials and published some more. I advise everyone to start with a systematic review to understand and find out what the world has done and then a large database analysis to assess if an association can be seen for the proposed idea.

    The VA has lead the world on this and an example of how investment in infrastructure for what is afterall a simple audit can lead to great things

    Many thanks

    Toby Richards
    Professor of Surgery
    Head, Division of Surgery UWA
    Director Clinical Trials Unit UWA
    CONFLICT OF INTEREST: None Reported
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