July 2, 2007
HOUSTON – Setting a record in the Department of Veterans Affairs, the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) has demonstrated consistently low observed-to-expected mortality rates in all surgery seven years in a row. The MEDVAMC is the only VA facility with this record.
"The entire surgical team, including surgeons, anesthesiologists, nurses, and our support staff, should be proud of their hard work in providing consistent, outstanding care to our veterans," said David H. Berger, M.D., MEDVAMC Operative Care Line executive.
By reviewing the accrual, workload, and outcome information on major surgery procedures performed at the MEDVAMC in fiscal years 1999 through 2006, health care providers have facts about comparative risk-adjusted outcomes of major surgery and reliable data about workload and length of stay. The ultimate use of this data is to improve the quality of surgical care to all veterans.
Beginning in fiscal year 1999 with 1,417 cases reported to the VA database for the MEDVAMC, the operative mortality was 2.8 percent and the observed-to-expected (O/E) mortality ratio was 0.85. In fiscal year 2006 with 1,426 reported cases, the operative mortality was 2.6 percent and the O/E mortality ratio was 0.72. The years between reflect the same trend.
An O/E ratio statistically significantly above one indicates that mortality is higher than what would be expected on the basis of the patient characteristics. An O/E ratio statistically significantly below one indicates that mortality is lower than what would be expected on the basis of the patient characteristics.
Prompted by the need to assess comparatively the quality of surgical care in VA hospitals, the Department of Veterans Affairs conducted the National VA Surgical Risk Study (NVASRS) in the early 1990s in 44 VA medical centers. The study developed and validated models for risk adjustment of 30-day morbidity and 30-day mortality after major surgery in eight non-cardiac surgical specialties. Similar models were developed for cardiac surgery by the VA’s Continuous Improvement in Cardiac Surgery Program (CICSP).
"The Michael E. DeBakey Veterans Affairs Medical Center continues to stand out as a pre-eminent institution, providing the best of care to our nation's veterans," said Peter G. Traber, M.D., president and CEO of Baylor College of Medicine. "This important recognition is well-deserved for Dr. Berger as well as his team of surgeons, nurses, and staff. Baylor takes great pride in its partnership with the DeBakey VA."
For more than 50 years, the MEDVAMC has provided clinical training for health care professionals through its major affiliate, Baylor College of Medicine. MEDVAMC now operates the largest VA residency program with more than 215 slots accounting for more than 580 residents per academic year.
"I am very proud the Michael E. DeBakey Veterans Affairs Medical Center has achieved such an important objective," said Thomas B. Horvath, M.D., F.R.A.C.P., MEDVAMC chief of staff. "Our surgical service staff and its practices are top-notch. I also want to mention the contributions the staff of our Anesthesiology Service has made toward the care and well-being of our veterans. Their role in our Operative Care Line is critical in reducing mortality rates in our medical center. I am pleased we serve as such a positive example for other hospitals both inside and outside the VA health care system."
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