Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

Abstract

Background: There are growing concerns that Veterans' increased use of Veterans Health Administration (VA)-purchased care in the community may lead to lower quality of care.Objective: We compared rates of hospital readmissions following elective total knee arthroplasties (TKAs) that were either performed in VA or purchased by VA through community care (CC) at both the national and facility levels.Methods: Three-year cohort study using VA and CC administrative data from the VA's Corporate Data Warehouse (October 1, 2016-September 30, 2019). We obtained Medicare data to capture readmissions that were paid by Medicare. We used the Centers for Medicare and Medicaid Services (CMS) methods to identify unplanned, 30-day, all-cause readmissions. A secondary outcome, TKA-related readmissions, identified readmissions resulting from complications of the index surgery. We ran mixed-effects logistic regression models to compare the risk-adjusted odds of all-cause and TKA-related readmissions between TKAs performed in VA versus CC, adjusting for patients' sociodemographic and clinical characteristics.Principal Findings: Nationally, the odds of experiencing an allcause or TKA-related readmission were significantly lower for TKAs performed in VA versus CC (eg, the odds of experiencing an all-cause readmission in VA were 35% of those in CC. At the facility level, most VA facilities performed similarly to their corresponding CC providers, although there were 3 VA facilities that performed worse than their corresponding CC providers.Conclusions: Given VA's history in providing high-quality surgical care to Veterans, it is important to closely monitor and track whether the shift to CC for surgical care will impact quality in both settings over time.

Outcomes of Veterans Treated in Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals

“…Other studies compared VA and community care purchased by the VA and focused on select subpopulations having a particular condition or receiving a particular procedure. 17 , 18 , 19 , 20 , 21 …”

Association of Quality of Care With Where Veterans Choose to Get Knee Replacement Surgery

“…[4][5][6][7] VA-performed surgical procedures, such as total knee arthroplasties (TKAs), have comparable or lower overall rates of complications and readmissions than VA-purchased surgical procedures. [8][9][10] However, these findings may obscure quality differences across VA facilities and across community health care facilities from whom the VA purchases care.…”

The MISSION Act Needs Measurement

“…Comparisons of surgical outcomes in VA and non-VA care settings rapidly followed. [3][4][5] These studies were well powered to determine quality of care for veterans overall and showed that surgical outcomes were either equivalent or better in VA hospitals. However, these studies were 90% male.…”

“…Veterans could now choose to have their surgical care at a VA hospital or at a community or academic hospital. Comparisons of surgical outcomes in VA and non–VA care settings rapidly followed . These studies were well powered to determine quality of care for veterans overall and showed that surgical outcomes were either equivalent or better in VA hospitals.…”