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Vets Getting a Raw Deal
The VA system could be so good and articles continue to be written about the care received at VA hospitals....not so good. Our vets deserve the best care and if you are getting operated on later in the day, this is what they write about:
Time of Day Is Associated With Postoperative Morbidity: An Analysis of the National Surgical Quality Improvement Program Data CME
Posted 04/30/2008
Rachel R. Kelz, MD, MSCE; Kathryn M. Freeman, BA; Patrick W. Hosokawa, MS; David A. Asch, MD, MBA; Francis R. Spitz, MD; Miriam Moskowitz, RN, MSN; William G. Henderson, MPH, PhD; Marc E. Mitchell, MD; Kamal M. F. Itani, MD, FACS
Disclosures
Abstract and Introduction
Abstract
Objective: To examine the association between surgical start time and morbidity and mortality for nonemergent procedures.
Summary Background Data: Patients require medical services 24 hours a day. Several studies have demonstrated a difference in outcomes over the course of the day for anesthetic adverse events, death in the ICU, and dialysis care. The relationship between operation start time and patient outcomes is yet undefined.
Methods: We performed a retrospective cohort study of 144,740 nonemergent general and vascular surgical procedures performed within the VA Medical System 2000-2004 and entered into the National Surgical Quality Improvement Program Database. Operation start time was the independent variable of interest. Logistic regression was used to adjust for patient and procedural characteristics and to determine the association between start time and, in 2 independent models, mortality and morbidity.
Results: Unadjusted later start time was significantly associated with higher surgical morbidity and mortality. After adjustment for patient and procedure characteristics, mortality was not significantly associated with start time. However, after appropriate adjustment, operations starting between 4 pm and 6 pm were associated with an elevated risk of morbidity (OR = 1.25, P ≤ 0.005) over those starting between 7 am and 4 pm as were operations starting between 6 pm and 11 pm (OR = 1.60, P ≤ 0.005).
Conclusions: When considering a nonemergent procedure, surgeons must bear in mind that cases that start after routine “business” hours within the VA System may face an elevated risk of complications that warrants further evaluation.
Gentlemen and ladies...start asking questions and insist on the high quality you deserve.
ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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