Comparing Veterans Affairs and Private Sector Perioperative Outcomes After Noncardiac Surgery

IMPORTANCE: Recent legislation facilitates veterans’ ability to receive non–Veterans Affairs (VA) surgical care. However, contemporary data comparing the quality and safety of VA and non-VA surgical care are lacking. OBJECTIVE: To compare perioperative outcomes among veterans treated in VA hospitals with patients treated in private-sector hospitals. DESIGN, SETTING, AND PARTICIPANTS: This cohort study took place across 8 noncardiac specialties in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) and American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 1, 2015, through December 31, 2018. Multivariable log-binomial modeling was used to evaluate the association between VA vs private sector care settings and 30-day mortality. Unmeasured confounding was quantified using the E-value. Patients 18 years and older undergoing a noncardiac procedures were included. EXPOSURES: Surgical care in either a VA or private sector setting. MAIN OUTCOMES AND MEASURES: Primary outcome was 30-day postoperative mortality. Secondary outcome was failure to rescue, defined as a postoperative death after a complication. RESULTS: Of 3 910 752 operations (3 174 274 from NSQIP and 736 477 from VASQIP), 1 498 984 (92.1%) participants in NSQIP were male vs 678 382 (47.2%) in VASQIP (mean difference, −0.449 [95% CI, −0.450 to −0.448]; P