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HSR&D 2004 National Meeting Abstracts

1041. Veterans Status Is Not An Independent Risk Factor for CABG Mortality
Dorothy A Bazos, PhD, VA Medical & Regional Office Center, White River Junction VAMC, DA Bazos, VA Medical & Regional Office Center, White River Junction VAMC, BM Bott, Dartmouth Medical School, SL Campbell, VHA Office of Quality and Performance, EL Hannan, University at Albany School of Public Health, MJ Racz, New York State Department of Health, SM Wright, VHA Office of Quality and Performance, ES Fisher, Dartmouth Medical School and VA Outcomes Group, White River Junction VAMC

Objectives: Recent studies demonstrating poorer cardiac care outcomes in VHA compared to the private sector raise the question of whether veteran status is an independent risk factor that explains these differences.

Methods: From New York’s Cardiac Surgery Reporting System (CSRS), we identified 3,032 enrolled veterans and 54,118 non-veterans who obtained isolated CABG between 1997-1999. Using the CSRS logistic regression model that adjusts mortality rates for patient and surgical characteristics, we compared risk-adjusted mortality rates for veterans to those for non-veterans undergoing surgery in private sector hospitals in New York. Using veteran status as a dummy variable in the regression model, we also calculated odds ratios for veteran compared to non-veteran mortality for each year and for the three-year period.

Results: Although the expected mortality rate was somewhat higher for veterans (2.42 (95% CI:1.92-2.95)) vs. 2.19 (95%CI:2.07-2.31), veterans had slightly lower risk-adjusted mortality rates compared to non-veterans undergoing CABG in private sector hospitals (2.05:95% CI:1.59-2.59 vs. 2.21:95%CI:2.09-2.34). We found no statistical difference in risk-adjusted mortality rates when comparing mortality rates in each year.

Conclusions: In New York, although veterans have more severe disease than non-veterans, veteran status is not an independent risk factor for CABG mortality in the private sector, after adjustment for the case-mix measures available in the CSRS.

Impact: Additional studies are needed to assess whether factors other than illness burden account for the higher mortality seen within VHA. In areas where access is challenging and monitoring systems are in place, VHA should consider contracting for CABG services.