Breast Cancer Surgery in Veterans Affairs and Selected University Medical Centers: Results of the Patient Safety in Surgery Study

Background: Breast cancer is a common diagnosis. We compare perioperative characteristics and outcomes between male and female patients undergoing treatment for breast cancer and between hospital systems (Department of Veterans Affairs [VA] and private sector [PS]) as part of the Patient Safety in Surgery (PSS) Study. Study Design: We performed an analysis of a prospectively collected clinical database. Data collected from 128 VA hospitals and 14 PS academic medical centers as part of the Patient Safety in Surgery Study for fiscal years 2002 through 2004 were used. Analysis included calculation of crude and adjusted odds ratios for morbidity. Results: A total of 3,823 patients were included. Female VA patients at baseline had higher rates of smoking, steroid use, COPD, acute renal failure, dialysis, weight loss > 10%, preoperative chemotherapy, and abnormal laboratory values than female PS patients did. Male patients were older than the female patients in both hospital systems. Mortality rates were very low and similar among groups. All VA patients in this study had substantially longer lengths of stay than the patients in the PS. The unadjusted overall complication rate was 5.21%; the VA female patients experienced an unadjusted complication rate twice that of the PS female patients. When adjusted for confounding variables and differences in preoperative comorbidities, the odds ratio comparing VA with PS females was no longer markedly different (1.404; 95% CI, 0.894, 2.204). Conclusions: VA patients with breast cancer have higher incidences of most comorbidities than patients in the PS. Differences in complication rates females disappear when adjustment is made for the higher rates of comorbidities in the VA patients.