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Research Letter
Association of VA Surgeons
December 2016

Association Between Postoperative Admission and Location of Hernia Surgery: A Matched Case-Control Study in the Veterans Administration

Author Affiliations
  • 1Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
  • 2Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
  • 3Health Care Financing & Economics, Department of Veterans Affairs, Boston, Massachusetts
  • 4Northeastern University, Boston, Massachusetts
  • 5Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts
  • 6Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2016;151(12):1187-1190. doi:10.1001/jamasurg.2016.3113

Within the Veterans Administration (VA) system, ambulatory surgery centers (ASCs) are gradually replacing traditional hospitals for outpatient surgical care.1 The expansion of ASCs is expected to continue as outpatient surgery increases. Although private-sector studies have shown that patient outcomes are better in ASCs than hospital outpatient departments (HOPDs),2-4 these settings have different financial incentives and a generally healthier population than the VA health care system. We examined postoperative outcomes (ie, hospital admissions) after inguinal hernia surgery in VA ASCs vs HOPDs.

We used the VA Corporate Data Warehouse fiscal years 2012-2014 outpatient procedure file to identify surgical procedures with a Current Procedural Terminology code of 49505 for repair of initial inguinal hernia. We obtained patient demographics, comorbidities, distance to VA hospital, median income, hospital bed supply in area of residence, American Society of Anesthesiologists score, facility’s geographic region, and date (month and year) of the hernia surgery from the Corporate Data Warehouse and the Area Health Resource File as model predictors. Facilities were excluded if they performed fewer than 30 hernia surgical procedures in fiscal years 2012-2014; cases were excluded if the patient lived more than 120 miles from a VA hospital or the surgery was emergent. Our final sample included 109 HOPDs and 14 ASCs. The VA Boston Healthcare System’s institutional review board approved this study and waived informed consent.