civilians with same illness
Veterans undergoing a major vascular surgery procedure were sicker when compared to patients undergoing the same surgery at civilian hospitals, yet the veterans had about the same results, according to a School of Medicine study in the September issue of the Journal of the American College of Surgeons.
"Interestingly, the outcome in both groups that underwent carotid endarterectomy (CEA) was about the same," says senior author Dr. Alan Dardik, assistant professor of vascular surgery. The operation involves removing plaque from a patient's carotid artery, the main artery in the neck that brings blood to the brain.
Dardik says this is the first study to demonstrate that patients in the Veterans Administration (VA) system may have higher rates of co-morbidity, or diseases in addition to the overriding problem, compared to similar patients in the general population. Increased co-morbidity typically influences the results of surgical procedures -- usually with a worse outcome for the patient.
"The results of this study suggest that patients undergoing vascular surgery at the VA may form a higher risk population than patients receiving care in non-VA hospitals," he says. "But despite the increased risk, this study also shows that these high-risk patients can undergo CEA safely."
The study looked at 7,089 CEAs performed in 37 Connecticut hospitals over five years. Of the total, 140 were performed at the VA Connecticut Healthcare System. Patients at the VA had higher rates of incidence of hypertension, diabetes, heart disease and kidney disease, as well as a higher rate of symptoms from their carotid disease.
"We believe the most interesting observation in our study is that differences exist between VA patients and the general population," he says. "Because our study was not designed to identify underlying reasons for these differences, it is unclear why VA patients have more severe disease than other patients in the state."
Dardik says that additional studies comparing VA patients to non-VA patients, using comparable reporting standards, are needed to understand the factors contributing to the severity of illness in veterans.
Co-authors include Dr. Jeffrey Weiss, Patrica Dumas, Dr. Charles Cha and Dr. Richard Gusberg of Yale.
-- By Jacqueline Weaver
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