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Combating Misconceptions of Cancer Surgery at VA Hospitals

As the nation’s largest integrated healthcare system, the Veterans Health Administration (VHA) provides care to nearly 10 million Veterans in over 1,000 facilities across the United States.

The VHA has faced scrutiny over the quality of its care in the past. However, several recent studies have shown that contrary to public sentiment the VA outperforms non-VA hospitals in several metrics of care for common clinical conditions.

A recent study by Washington University researchers, published in Annals of Surgery, compared outcomes between patients receiving care for lung cancer at VA versus non-VA hospitals.

“In our study, we sought to examine patients with early-stage lung cancer, comparing the quality of surgical care received through VA versus civilian hospitals,” says principal author Brendan Heiden, MD, MPHS, research fellow in the Division of Cardiothoracic Surgery at Washington University School of Medicine in St. Louis.

For this retrospective cohort study, Heiden collaborated with faculty from the Divisions of Cardiothoracic Surgery and Public Health Sciences, the Institute for Clinical and Translational Sciences, and physicians from the VA St. Louis Health Care System to compare operative characteristics and outcomes between the patients receiving treatment at VHA facilities and non-VHA facilities. The team hypothesized that Veterans receiving surgery through VA hospitals receive high-quality care and have similar outcomes compared to the general population.

The researchers analyzed 10 years’ worth of patient data collected from the VA Health Care System and compared this to the National Cancer Database, which represents civilian hospitals. The team’s primary outcome of interest was comparing long-term survival between these different care settings. However, they also compared several secondary outcomes including various surgical quality measures (like the rate of minimally invasive surgeries), hospital length of stay, and hospital readmission rates.

“The Department of Surgery has a long-standing tradition of promoting high-powered academic research to advance our understanding of several diseases and cancers,” says Heiden. “Projects like this are only possible due to the generous support of the Department and its faculty. It is also important to recognize our large team of researchers from the VA who work tirelessly to better the care of Veterans in our country.”

The study revealed that Veterans who receive care for their early-stage lung cancer through the VA receive exceptional care with favorable outcomes, including significantly longer overall survival, compared to the general population.

“The primary means of combating the misconceptions about surgical care in the VA is through the direct patient care that we deliver with a compassionate presence and the resultant outcomes that our patients share with their friends and family,” says Mayank R. Patel, MD, thoracic surgeon and Chief of Surgery at VA St. Louis Health Care System, who collaborated with Heiden and the Department of Surgery faculty on this project.

The researchers explained that facilities like the VA St. Louis Healthcare System are often staffed by surgeons from nearby academic medical centers – in this instance, Washington University School of Medicine – which may help to explain the superior outcomes that they observed in their study.

“Our partnerships with our academic affiliates has helped us develop a comprehensive surgical service with superior clinical outcomes and academic opportunities to advance surgical care,” says Patel. “This combined with the unique resources available to Veterans through VHA allows us to fulfill our mission to provide our nation’s heroes with the best care available right here in St. Louis.”